The biceps muscle is in front of your upper arm. It helps you bend your shoulder & elbow as well as rotate your arm.Tendons attach muscles to bones. The biceps muscle has two origins; the short and long head of biceps (LHB). The short head of biceps inserts in to the tip of the corocoid process, which is a bony projection off the front of the shoulder blade (scapula). This is located outside the shoulder in contrast to the LHB, which originates from within the shoulder joint itself.
Many people can still function with a biceps tendon tear, and only need simple treatments to relieve symptoms. Some people require surgery to repair the torn tendon.
What are the problems with biceps / Long Head Biceps?
The LHB is vulnerable as it travels through the shoulder joint to its attachment point in the socket. The short head of the biceps rarely tears. Because of this second attachment, many people can still use their biceps even after a complete tear of the long head.
More often patients experience pain before the LHB tears and the pain is often relieved. It usually accompanies a sensation of tear/pop/snap and bruising in the arm. When you tear your biceps tendon, you can also damage other parts of your shoulder, such as the rotator cuff tendons.
Partial tear: Many tears do not completely sever the tendon.
Complete tears: A complete tear will split the tendon into two pieces.
Biceps instability:after passing through the shoulder joint, the LHB exits the front of the shoulder and continues down the arm.
Tendinitis: In this situation the tendon is inflamed and often thickened and causes pain in the front of the shoulder which is made worse on loading. In many cases, torn tendons begin by fraying. As the damage progresses, the tendon can completely tear, sometimes with lifting a heavy object.
The LHB tendon is more likely to be injured.
What Causes it?
If you fall hard on an outstretched arm or lift something too heavy, you can tear your biceps tendon.
Many tears are the result of a wearing down and fraying of the tendon that occurs slowly over time. Overuse can cause rotator cuff problems as well as biceps issues. Having any of these conditions puts more stress on the biceps tendon, making it more likely to weaken or tear.
- Risk Factors
Your risk for a tendon tear increases with:
Age. Older people have put more years of wear and tear on their tendons than younger people.
Heavy overhead activities. Too much load during weightlifting is a prime example of this risk, but many jobs require heavy overhead lifting and put excess wear and tear on the tendons.
Shoulder overuse. Repetitive overhead sports – such as swimming or tennis – cause more tendon wear and tear.
Smoking. Nicotine use can affect nutrition in the tendon.
Corticosteroid medications. has been linked to increased muscle and tendon weakness.
What are the symptoms?
- Sudden, sharp pain in the upper arm
- Sometimes an audible pop or snap
- Cramping of the biceps muscle with strenuous use of the arm (in cases chronic LHB rupture)
- Bruising from the middle of the upper arm down toward the elbow (acute tear)
- Weakness in the shoulder and the elbow
- Difficulty turning the arm palm up or palm down
- Because a torn tendon can no longer keep the biceps muscle tight, a bulge in the upper arm above the elbow (“Popeye Muscle”) may appear, with a dent closer to the shoulder.
- In addition, rotator cuff injuries, impingement, and tendonitis are some conditions that may accompany a biceps tendon tear.
How is it diagnosed?
The diagnosis is usually based on a good clinical history and physical examination. Diagnosis of biceps tendinopathy or tear can be made clinically. If the LHB is completely torn then patients may develop a ‘Popeye Sign’ which is bunching of biceps tendon in upper arm.
The diagnosis of LHB tendinitis / tear is mainly based on history and physical examination. Plain radiographs, ultrasound and / or MRI scan may be requested to look for other pathologies around the shoulder.
- Conservative treatment comprising of rest, activity modification and non-steroidal anti-inflammatory may be helpful in the early stages and when symptoms are mild
- Physiotherapy: A rehabilitation programme may be directed by a physical or occupational therapist may be helpful in stretching the joint and preventing the loss of movements. The success depends on the level of pain and expectations.
- Injections: An ultrasound or fluoroscopy guided injection around the LHB provides a decrease in inflammation and reduces pain. Cortisone’s effects are often temporary, but it can give very effective relief in the short term. It also aids in confirming the diagnosis.
- Arthroscopic Technique
If the non-operative treatment fails, then the commonest form of surgical intervention is either a biceps tenotomy – where the LHB is released from its attachment in the socket or Biceps Tenodesis – where the LHB is re-sited and re-attached to a different site.
After surgery, the arm will be placed in a sling for a short period of time. This allows for early healing. As soon as comfort allows, the sling may be removed to begin exercise and use of the arm.
- Open Technique:
If the LHB is already torn then an open technique is usually used. This involves a 4 – 5 cm incision in front of the arm to find and reattach the tendon to a different position.