A biceps tendon tear, or rupture, occurs when the long head of the biceps partially tears or ruptures from its attachment to the top of the socket. It is commonly associated with other painful shoulder conditions such as rotator cuff disease or osteoarthritis. In most cases, this condition is managed without surgery with no long-term effects to shoulder function.
The biceps muscle has two tendons at the shoulder, the short head and long head. The short head of the biceps is attached to the shoulder blade away from the joint and is rarely a cause of shoulder pain. The long head of the biceps is a more complicated structure. It travels in a groove on the front of the humerus bone, underneath the rotator cuff tendon, and into the shoulder joint, attaching to the top of the socket and the superior labrum. Even if the long head of biceps ruptures, the short head remains attached to the shoulder blade.
There are many different factors that contribute to a biceps tear or rupture. Hand dominance, and repetitive motion related to occupation or recreational activities commonly cause this condition. Since the tendon takes a long, circuitous path to its attachment, it is particularly vulnerable to injury from the friction between bone and the tendon. Moreover, a biceps rupture is often the end result of chronic degeneration and tends to occur in older patients. It is often associated with other shoulder conditions, including rotator cuff tears and osteoarthritis.
SIGNS AND SYMPTOMS
Patients with a ruptured biceps often experience pain along the front of their shoulder at the location of the bicipital groove. This pain can occur with rest and with activity. The pain often worsens with activities above shoulder level. Further, there may be tenderness in this area as well. If there is also instability of the biceps, you may feel a snapping sensation as the biceps slips out of its groove with certain movements.
Patients with a biceps rupture will commonly describe a pop or snap relating to strenuous activity. Some patients also describe cramping of the biceps following the injury. Also, patients develop a cosmetic deformity of the biceps called a “popeye sign”. This happens when the muscle belly of the biceps drops down toward the elbow. Weakness is typically a result of pain, since the short head of biceps and the more powerful brachialis muscle preserve the elbow’s flexion strength.
Your physician will diagnose this condition based on your medical history and a physical examination. He or she will test certain shoulder positions to confirm the location of the shoulder pain. Your doctor may order X-rays to identify other conditions that accompany biceps tears, such as osteoarthritis. While an MRI is not necessary to diagnose a biceps tendon tear or rupture, it can be helpful to confirm the diagnosis and to identify associated conditions. An ultrasound is less commonly used, however, it serves as a helpful, quick look at biceps tendon ruptures and rotator cuff tears in patients who cannot obtain an MRI.
Many patients with a biceps tendon tear will respond to nonsurgical management. Your orthopedist will usually recommend:
A period of rest from strenuous activities and athletics.
Periodic icing to alleviate pain.
Non-steroidal and anti-inflammatory medications to diminish inflammation and pain.
A home exercise program of simple rotator cuff and biceps stretching and strengthening exercises.
The doctor will typically prescribe a physical therapy program for patients who do not respond to this initial approach. The physical therapists will use modalities to decrease inflammation and pain and improve the range of motion and strength of the rotator cuff and biceps. Therapists will also address any associated conditions.
In some instances, injections can provide relief for patients with significant pain. These injections are often performed under ultrasound guidance to improve accuracy into the biceps tendon sheath.
Your shoulder surgeon may recommend a surgical procedure if you continue to experience pain despite conservative treatment or if you have shoulder instability. During the procedure, the surgeon will release the tendon from its attachment in the shoulder (tenotomy), or release and reattach the tendon lower down on the humerus (tenodesis).
Various factors determine the appropriate procedure for each patient, such as age, hand dominance, activity level, and occupation. Postoperative recovery, including duration in a sling, a physical therapy program, and recovery time are most often determined by the primary surgery performed at the same time as the biceps procedure.