What is Biceps Tendon Rupture?
Biceps Tendon Rupture explained: The biceps muscle has two tendons, meaning there are two attachments points (long and short head), but one singular muscle belly. When the bicep tendon completely tears from the attachment point, it is called a rupture. Typically, a rupture occurs with the long head tendon because of years of wear and tear breaking down tissue or due to prior shoulder injuries such as shoulder tendinitis or impingement (link to articles).
To understand how a bicep rupture happens, an understanding of basic shoulder anatomy is key. The long head bicep (LHB) attaches to the front of the shoulder at the labrum which is a fibrous cartilage to hold the shoulder joint in place. When a rupture to the bicep head occurs, typically it is easy to see visually as the bicep muscle “coils” up within the arm, which is commonly known as a “Popeye Arm.”
A compact joint like the shoulder doesn’t have a lot of room for the muscles, tendons, and ligaments to attach or pass through the joint space. There is a cushion, called the bursa sac, which helps prevent wear and tear of these tissues that make up the rotator cuff (link to article). However, the bursa sac gives little to no protection for the LHB attachment, which means with frequent or repetitive activities over the years, can cause “fraying” or a breakdown of the LHB attachment. (insert image of shoulder joint with long bicep head)
A multi-directional joint like the shoulder is at higher risk of injury compared to other joints within the body. The more mobility, the more structure, like bones and tissue, are needed to help stabilize the joint (hold it together), which also means when one structure is injured there is a higher risk of surrounding tissue being impacted. When one breaks down, other tissue in the area may also be affected either in conjunction with each other or over time one by one it slowly wears down.
The bone structure of the shoulder links it to the susceptibility of the LHB injury. The upper arm (humerus) and shoulder blade (scapula) come together to form the primary movement of the shoulder, lifting the arm overhead. When you lift your arm overhead, the space between the humerus and the scapula (the area where the LHB attaches) becomes more compact. With this compact space, the tissue like the LHB is likely to have more friction, shearing, or compression. Over time, in some people, this can become an issue.
Quite commonly, one will experience a breakdown of other tissue within the shoulder before the LHB attachment becomes irritated or ruptures. So, in most cases, a rupture may be preventable if treatment of your shoulder pain is addressed early. Breaking the pattern of wear and tear through early and proper treatment and intervention will likely prevent an injury of the LHB attachment.
What causes biceps rupture?
A biceps rupture typically occurs because of overuse of the arm. Fraying of the tendon tissue, also known as degeneration, is caused by years of repetitive activities such overhead reaching or lifting, poor body mechanics and posture, and shoulder weakness or stiffness.
Typically, there is a history of having other shoulder conditions before a rupture and they are:
- Unresolved pain
Symptoms of Biceps Tendon Rupture
To minimize your risk of having a biceps rupture, early intervention to shoulder pain is key. If you are experiencing persistent shoulder pain, we recommend you check in with your physical therapist or physician.
The most commonly reported symptoms of a biceps rupture include:
- Bruising and/or swelling of the upper arm
- Bulge or deformity above the elbow
- Hearing a “pop” or “snap” noise
- Muscle spasms
- Sharp pain in the upper arm
- Tenderness to touch
- Weakness of the arm
How is a biceps rupture diagnosed?
Most often, with a naked-eye’s view, there is a bulge in the affected arm. If there are a minor tear and not a full rupture, the bulge may not be present. When the rupture occurs, people will often report relief of their shoulder pain symptoms, but instead are now left with a bulge in their arm.
Your physician will complete a full history and examination to determine the diagnosis and treatment approach. Diagnosis can occur without imaging, but sometimes a physician will order an X-ray or MRI to get an internal look at the shoulder and surrounding tissue, which will help determine if there is any other damage beyond the biceps.
Treatment of Biceps Tendon Rupture
Not all bicep ruptures need surgery. The short head of the bicep tendon is typically still attached so, for the most part, arm movement still work. The arm will not have a full strength which is one of the determining factors if you need surgery or not.
There are several key factors to determine if you need bicep reattachment or repair surgery. Commonly, the elderly may not need surgery due to several factors. One, if they are retired or still working but don’t need the use of their arm for labor work. Also, if there are other medical complications where having surgery is a risk. Finally, if you can complete all daily functional activities with minimal difficulty then in these cases surgical intervention may not be needed.
For all others who are active, need to work, and are concerned about cosmetics of the arm, then surgery may be recommended. With surgery, the bicep tendon is reattached to the humerus so that the arm can return to full function.
On a rare occasion, depending on the condition of the surrounding tissue and bone structures, the surgeon may need to reshape the acromion (the top of the shoulder bone) which is called an acromioplasty. This is typically done because more space is needed to alleviate any pressure on other structures within the joint.
Regardless of having surgery or not, physical or occupational therapy (PT or OT) services are recommended. The main goal is to reduce pain and swelling and to regain the strength of the shoulder region. A PT or OT will retrain muscles to improve proper movement patterns, provide instruction on appropriate exercises, and assist with returning to function.
Physical and occupational therapy is not a cookie cutter approach which is why each client needs to an evaluation and a customized treatment plan created. As a consumer of health care, you have a choice in the provider you receive care from. Do your homework and look for a PT or OT quality outcomes and customer reviews. The best way to find a highly qualified PT or OT near you is to click on Find A Clinic.
A highly qualified PT or OT will track outcomes of your care. He or she will track your customer experience to ensure he or she is exceeding your expectations. Also, tracking your outcomes to have inconclusive data on your progress of care. Tracking key data points is an integral part of your recovery.
In severe cases where conservative treatment does not work, your physician may recommend anti-inflammatory injection to help manage the pain, which is not a cure, so PT or OT is recommended in conjunction with this treatment.
In the most severe cases, surgical intervention is needed. When all other avenues to control symptoms and improve function have failed, then a surgeon will repair the shoulder through a minimally invasive procedure called tenodesis or SLAP (superior labrum anterior to posterior) lesion repair. The surgeon cuts the bicep tendon head from the labrum and reattaches it to the humerus to alleviate the pressure on the labrum and biceps tendon. Post-surgery, your arm will likely be in a sling for about three weeks. Time away from work depends on the severity of the condition of the shoulder and what type of work you perform. Typically, a surgical candidate will be off work anywhere from 3-weeks to 6-months. It is recommended you consult with your physician for return to work expectations before your surgery.
During the recovery period after surgery, physical or occupational therapy is highly recommended. PTs and OTs can help manage pain, improve range of motion, and return to activities such as work and hobbies safely.
Early intervention and treatment of shoulder pain is key to conservative care in getting you back to doing the things you love. If you are experiencing shoulder pain impacting your daily activities such as work and hobbies, then see a medical professional like a physical or occupational therapist.
Most states have direct access to a physical therapist, meaning you can go directly to a physical therapist without a physician order. To determine if your state has direct access, please visit the American Physical Therapy Association’s website Physical Therapy Direct Access By State.
If you are uncertain with how direct access works in your state, a good starting point would then be to visit with your primary physician. He or she can establish a plan with you to ensure you are getting the health care you need.