-Cyprus Orthopaedics

Biceps Tendon Raptures

A biceps tendon tear is a tear of the far end of the biceps tendon, which tends to affect active individuals over the age of 35 years. It is also referred to as a “Rupture of the distal biceps tendon”.
Elbow Conditions-Cyprus Orthopaedics

Biceps Tendon Raptures

Anatomy of the Biceps Tendon

To understand biceps tendon ruptures, it is essential to have a basic knowledge of the anatomy involved. The biceps tendon is a strong cord-like structure that connects the biceps muscle to the bones in the shoulder and elbow. It is responsible for bending the elbow and rotating the forearm. The biceps tendon is composed of two parts: the long head and the short head. The long head attaches to the top of the shoulder socket, while the short head attaches to a bone in the forearm called the radius. The biceps tendon is surrounded by a protective sheath called the synovium, which helps reduce friction during movement

Causes of Biceps Tendon Raptures

Biceps tendon ruptures can occur as a result of sudden trauma or overuse injuries. The most common cause of biceps tendon ruptures is a sudden and forceful contraction of the biceps muscle. This can happen during activities such as heavy lifting, throwing, or falling onto an outstretched arm. Overuse injuries, on the other hand, can lead to gradual degeneration of the tendon over time, eventually resulting in a rupture. Factors that can increase the risk of biceps tendon ruptures include age (as tendons become less flexible and more prone to injury with age), smoking (which can impair blood flow to the tendons), and certain sports or occupations that involve repetitive overhead motions.

Symptoms of Biceps Tendon Raptures

When a biceps tendon rupture occurs, it is often accompanied by immediate and severe pain in the upper arm or shoulder. You may also experience a popping or snapping sensation at the time of injury. Swelling and bruising may develop in the affected area, and there may be a visible deformity in the arm or shoulder. Other symptoms can include weakness or difficulty in bending the elbow or rotating the forearm. It is important to note that not all biceps tendon ruptures cause significant pain or noticeable symptoms, especially in cases of partial tears. However, seeking medical attention is still recommended to prevent further damage and ensure proper healing.

Diagnosis of biceps tendon ruptures

  Your doctor will perform a thorough physical examination, checking for visible deformities, swelling, and tenderness in the affected area. They may also perform specific tests to assess the strength and range of motion in your arm and shoulder. Imaging tests such as X-rays, ultrasound, or magnetic resonance imaging (MRI) may be ordered to confirm the diagnosis and assess the extent of the injury. These tests can help determine whether the tear is partial or complete and whether other structures in the shoulder or elbow are affected.

Treatment Options for Biceps Tendon Raptures

The treatment approach for biceps tendon ruptures depends on various factors, including the severity of the injury, the individual’s age and activity level, and the presence of any associated shoulder or elbow conditions. Non-surgical treatment options are typically considered for individuals with partial tears, minimal symptoms, or those who may not be suitable candidates for surgery. Non-surgical treatments can include rest, ice, pain medications, physical therapy, and the use of supportive devices such as slings or braces. Surgical intervention may be recommended for complete tears, significant pain or functional impairment, or for individuals who require full restoration of strength and range of motion. Surgical procedures can involve reattaching the torn tendon to the bone using various techniques, depending on the specific case and the surgeon’s preference.

Rehabilitation and Recovery for Biceps Tendon Raptures

After surgical or non-surgical treatment for biceps tendon ruptures, rehabilitation and recovery play a crucial role in restoring functionality and preventing re-injury. Physical therapy is often prescribed to help improve strength, flexibility, and range of motion in the affected arm and shoulder. The rehabilitation program may include exercises to strengthen the biceps muscle, as well as other muscles surrounding the shoulder and elbow. Gradual progression of exercises and activities is essential to avoid overloading the healing tendon. It is important to follow the guidance of your healthcare provider and physical therapist throughout the recovery process to achieve the best possible outcome.

Preventing Biceps Tendon Raptures

While it may not be possible to prevent all cases of biceps tendon ruptures, there are steps you can take to reduce the risk of injury. Maintaining overall physical fitness, including regular exercise and strength training, can help keep your tendons strong and resilient. It is important to use proper techniques and body mechanics when engaging in activities that involve repetitive overhead motions or heavy lifting. Avoiding sudden, forceful movements and gradually increasing the intensity and duration of your workouts can also help prevent overuse injuries. If you participate in sports that involve throwing, such as baseball or softball, it is crucial to warm up properly, use proper throwing techniques, and listen to your body’s warning signs of fatigue or pain. If you have any concerns about the health of your biceps tendon or are at a higher risk due to age or other factors, consult with a healthcare professional for guidance and appropriate preventive measures.

Partial tears may heal and may need protection during healing. Complete tears of the biceps tendon do not heal naturally as the tendon is pulled up into the arm by the biceps muscle.

Healthy tendons rarely tear. A biceps tendon tear occurs when a tendon weakened by wear and tear in the tendon is overloaded.

Partial tear: As the name suggests only part of the tendon is torn. As part of the tendon is intact there is no change in the shape of the muscle.

Complete tear: When the tendon is completely torn the tendon gets pulled up by the muscle and shape of the muscle changes.

A diagnosis of biceps tendon tear is made based on the history of sudden pain and a snapping sensation on the front of the elbow whilst lifting a heavy object. This may be associated with a feeling of weakness. Examination in individuals with a complete tear of the tendon shows a change in the contour of the biceps muscle referred to as a reverse “Popeye” sign. There may be some bruising on the front of the elbow. In the injured elbow it is not possible to hook a finger around the biceps tendon at the elbow (a positive “hook” test). In individuals with partial tears the tendon may be felt at the elbow but will be tender on squeezing. An ultrasound or MRI scan may be requested if the diagnosis is in doubt.

In the early phase, pain may be controlled with the use of pain relieving or anti-inflammatory medication.

Nonsurgical treatment: Partial tears may be treated initially with activity modification, protection and physiotherapy. Less active individuals with complete tears may choose not to have surgery for this injury. Pain usually settles fairly quickly but individuals may experience some weakness of the elbow or aching particularly with activities, which require twisting movements of the forearm. Physiotherapy is helpful to restore movements and strengthen the muscles which compensate for the torn biceps tendon.

Surgery: For partial tears, surgery may be considered if the symptoms have not responded to a period of nonsurgical treatment. Most active individuals with complete tears of the biceps tendon will be offered the choice of having the tendon repaired surgically. The operation is best performed within the first 2-3 weeks after the injury. Outcomes are generally good. For further information on surgical treatment, please refer to the section on “Biceps tendon repair at the elbow”.

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