Biceps Tendon Conditions
The biceps muscle in front of the upper arm connects to the shoulder bones via two tendons. The upper tendon, also called the long head of the biceps, can become inflamed or irritated with overuse or age leading to pain and weakness. This condition is called biceps tendinitis.
Biceps tendinitis can occur with sports and job-related activities that involve repetitive overhead arm movements. Wear and tear of the tendon can also accumulate with age.
The tendon initially becomes red and swollen and its sheath covering gradually starts to thicken. As the condition progresses, the entire tendon thickens and grows larger and dark red. It may occasionally tear leading to a bulge in the upper arm. Pain is felt along the front of the shoulder or upper arm and worsens with overhead activities. An occasional snapping sensation may also be present. Biceps tendinitis may occur along with other conditions such as rotator cuff tear, osteoarthritis, or shoulder instability (dislocation).
When you present to the clinic, your doctor will review your symptoms and history and perform a physical examination to evaluate the range of motion, strength and stability of the shoulder. Specific tests are performed the examine the biceps. Imaging studies such as X-rays or an MRI may be ordered to view the biceps, the shoulder joint and associated muscles.
Your doctor will first treat biceps tendinitis by non-surgical methods which include rest, ice and anti-inflammatory medications. Steroid injections are administered for more effective pain relief. Physical therapy helps stretch and strengthen the biceps and other muscles of the shoulder joint. Surgery is advised when your condition does not improve or when other conditions such as a rotator cuff tear are present.
Surgery is usually performed through an arthroscope (viewing tube) using miniature instruments but may sometimes require an open incision. The damaged section of the biceps tendon is either repaired or removed with reattachment of the remaining tendon to the upper arm bone (tenodesis). In severe cases where repair or tenodesis is not possible, the damaged tendon is simply released from its attachment (tenotomy) to relieve symptoms. Following surgery, you will be in a sling for a few weeks and a rehabilitation program is recommended to help you regain normal function and range of motion of the shoulder.
The biceps muscle is present on the front side of your upper arm and functions to help you bend and rotate your arm. The biceps tendon is a tough band of connective fibrous tissue that attaches your biceps muscle to the bones in your shoulder on one side and the elbow on the other side. Overuse and injury leads to fraying of the biceps tendon and eventual rupture.
A Biceps tendon rupture can either be partial, where it does not completely tear the tendon, or complete, where the biceps tendon completely splits in two and is torn away from the bone.
The Biceps tendon can tear at the shoulder joint or elbow joint. The majority of biceps tendon ruptures occur at the shoulder and is referred to as proximal biceps tendon rupture. When it occurs at the elbow it is referred to as a distal biceps tendon rupture, however this is much less common.
Biceps tendon ruptures occur most commonly from an injury, such as a fall on an outstretched arm, or from overuse of the muscle, either due to age or from repetitive overhead movements such as with tennis and swimming.
Biceps tendon ruptures are common in people over 60 who have developed chronic micro tears from degenerative changes and overuse. These micro tears weaken the tendon making it more susceptible to rupturing.
Other causes can include frequent lifting of heavy objects while at work, weightlifting, long term use of corticosteroid medications and smoking.
The most common symptoms of a biceps tendon rupture include:
- Sudden, sharp pain in the upper arm
- Audible popping sound at the time of injury
- Pain, tenderness and weakness at the shoulder or elbow
- Trouble turning the arm palm up or down
- Bulge above the elbow (Popeye sign)
- Bruising to the upper arm
Your doctor diagnoses a biceps tendon rupture after observing your symptoms and taking a medical history. A physical exam is performed where your arm may be moved in different positions in order to see which movements elicit pain or weakness. Imaging studies such as X-rays may be ordered to assess for bone deformities such as bone spurs, which may have caused the tear or an MRI scan to determine if the tear is partial or complete.
Nonsurgical Treatment: Nonsurgical treatment is an option for patients whose injury is limited to the top of the biceps tendon.
Nonsurgical treatment includes:
- Rest: A sling is used to rest the shoulder and you are advised to avoid overhead activities and heavy lifting until healed.
- Ice: Applying ice packs for 20 minutes at a time, 3 to 4 times a day, helps reduce swelling.
- Medications: Non-steroidal anti-inflammatory medicines help reduce pain and swelling.
- Physical therapy: Strengthening and flexibility exercises help restore strength and mobility to the shoulder joint.
Surgery may be necessary for patients whose symptoms are not relieved by conservative measures and for patients who require full restoration of strength, such as athletes.
Your surgeon makes an incision either near your elbow or shoulder, depending on which end of the tendon is torn. The torn end of the tendon is cleaned, and the bone is prepared by creating drill holes. Sutures are woven through the holes and the tendon to secure it back to the bone and hold it in place. The incision is then closed, and a dressing applied.
Risks and Complications
As with any surgery, complications can occur related to the anesthesia or the procedure. The majority of patients suffer no complications following biceps tendon repair, however, complications can occur and may include:
- Nerve damage
- Re-rupture of the tendon