Proximal Bicep Tendon Background:
Proximal Bicep tendon tears can be related to a shoulder injury. The biceps are the muscles located on the front of the upper arm. It is a strong muscle in the upper arm region that helps you to rotate your forearm, lift things and twist your elbow. The biceps tendons attach the biceps muscle to bones in both the shoulder and elbow. If these tendons become torn, either through a fall, a sports related injury or from extreme wear and tear, strength in the upper arm can become lost and movement in the upper arm painful.
There are a couple of varieties of a biceps tendon tear:
- A partial tear is a tear that does not completely sever the tendon.
- Full-Thickness tears that can occur at the shoulder (proximal tears) or at the elbow (distal tears)
Most tears are the result of on-going, continuous strain and wear and tear (chronic) on the biceps muscle and tendon. This is most commonly seen in weight and strength training and usually starts with just a simple fraying of the tendon. As the injured tendon progresses, it will eventually tear.
These tears can occur in two distinct ways:
- At the shoulder joint: A proximal biceps tendon rupture is an injury to the biceps tendon as it enters the shoulder joint. The tendon is vulnerable to injury here because it makes a sharp right-turn to enter the shoulder joint and it moves in and out the shoulder up to 2 inches with shoulder motion. This is the most common area for the bicep tendon to tear and typically occurs in patients 60 years of age or older. In some instances, it creates minimal symptoms and can heal on its own; in other cases, there is significant deformity (Popeye muscle) and cramping. In some cases, surgery can be helpful to treat the symptoms of cramping, weakness, and deformity.
- Biceps Tendon Tear or Rupture at the elbow joint: A distal biceps tendon rupture is an injury that occurs at the elbow joint. It most commonly affects middle-aged men and is caused by heavy lifting or sports. There is usually a loud ‘pop’ when the tear occurs. Most people who suffer from this injury will need to have surgery in order to correct the problem.
Symptoms of Bicep Tendon Injury
Symptoms associated with a torn biceps tendon include sudden, sharp upper arm pain, sometimes with a noticeable snap or popping sound. Cramping, bruising, pain and tenderness of the shoulder, biceps and elbow are common. In addition, it will most likely be difficult to turn the palm of the hand up or down. People also complain of a “Popeye” deformity, which is indicated buy a low sitting muscle belly in the arm. It has a “balled-up” appearance.
Treatment for Bicep Tendon Injury
It is important to note that the biceps have two attachments at the shoulder: a long head and a short head. The long head is the tendon at the shoulder that is most frequently injured. Short head biceps injuries are exceedingly rare, while long head biceps injures are exceedingly common. Because of this second attachment at the shoulder, many people can still function and use their biceps even when the long head of the biceps is severely damaged or completely torn. With that said, many people can still function with a biceps tendon tear, and only need simple treatments to relieve symptoms.
Chronic tears in general are harder to treat with surgery compared to traumatic or acute tears. With chronic tears the muscle has been torn for some time and becomes “scared in”. It’s like taking a rubber band that has snapped and hasn’t been used in a while and then trying to stretch it back out…it tends to just fall apart. Same theory applies to tendons that haven’t been mobilized in several months. For these patients we typically recommend a non-surgical approach unless the patient understands the risks of the surgery and wish to attempt a repair.
Treating a torn biceps tendon non-surgically will include resting the arm that is injured and avoiding any heavy lifting or the activity that may have caused the injury. Applying cold packs and ice will help with swelling and overall pain. You can also take anti-inflammatory medications and non-steroid drugs for pain relief. If this is not working for you, we typically then recommend a surgical approach.
Biceps Tenodesis Surgery
The goal of the surgery is to re-anchor the torn tendon back to the bone. At the shoulder, the long head of the biceps is typically re-attached using a sub-pectoral approach that anchors the long head biceps tendon into the upper part of the arm bone using a small screw anchor and suture. Once it is healed, patients have normal strength and function, the scar becomes invisible in the armpit, and the muscle appearance returns to normal. Excellent results can be expected with full recovery in 3-4 months. This procedure is also performed in conjunction with rotator cuff tears as the proximal biceps tendon is typically injured when the rotator cuff is injured.
Please watch the video below for more information on how we repair a proximal bicep tendon tear.
Also, visit this link for proximal tendon ruptures: http://www.orthobullets.com/sports/3045/proximal-biceps-tendonitis
and this link for distal bicep tendon ruptures: http://www.orthobullets.com/sports/3081/distal-biceps-avulsion