The biceps muscle is present on the front of your upper arm and functions to help you bend and rotate your forearm. 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.
What is a Biceps Tendon Rupture?
Overuse and injury can cause 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 tendon completely splits in two and is torn away from the bone.
The biceps tendon can tear at the shoulder joint or elbow joint. Most biceps tendon ruptures occur at the shoulder (long head of biceps tendon) and are 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 less common.
What are the Causes of Bicep Tendon Rupture?
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..
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 rupture.
Other causes can include frequent lifting of heavy objects while at work, weightlifting, long-term use of corticosteroid medications and smoking.
Distal bicep tendon ruptures usually always occur as a result of trauma. These tend to occur in younger patients and most commonly are the result of a forced straightening of the elbow when trying to lift something heavy.
Symptoms of Bicep Tendon Rupture
The most common symptoms of a proximal biceps tendon rupture include:
- Sudden, sharp pain in the upper arm and shoulder region
- Audible popping sound at the time of injury
- Pain, tenderness, and weakness at the shoulder
- Bulge (Popeye sign) in the region of the biceps muscle
- Bruising to the upper arm
The most common symptoms of a proximal biceps tendon rupture include:
- Sudden, sharp pain in the front of the elbow
- Audible popping sound at the time of injury
- Pain, tenderness, and weakness at the elbow
- Retraction of the biceps muscle up the arm
- Bruising to the elbow and forearm
How is a Bicep Tendon Rupture Diagnosed?
Your doctor diagnoses a biceps tendon rupture after observing your symptoms and reviewing your medical history. A physical exam is performed where your arm may be moved in different positions to see which movements elicit pain or weakness and deformity of the biceps can be identified. Imaging studies such as X-rays may be ordered, but soft tissue imaging is usually required for the diagnosis, including an ultrasound or MRI. An MRI scan is best to determine if the tear is partial or complete.
Treatment Options for Bicep Tendon Rupture
Non-surgical treatment is usually the preferred option if the injury is limited to the top of the biceps tendon (long head of biceps).
Surgery may be necessary if symptoms are not relieved by conservative measures and if full restoration of strength is required in case of athletes. Often the long head of the biceps does not tear in isolation and may be associated with tears of the rotator cuff. These may need surgical treatment in their own right.