Biceps Tendon Rupture
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What is a biceps tendon rupture?
The biceps is a muscle on the front part of the upper arm—the “Popeye” muscle you flex to show strength. It is attached to bones in the arm with tough connective tissue called tendons. When a tendon tears away from where it is attached, that is called a rupture, or avulsion.
A proximal (near the shoulder) biceps tendon rupture is usually caused when a heavy load is placed on your flexed arm, forcing it to straighten quickly. It can happen when weight lifting, playing sports, or also doing strenuous household chores.
A biceps tendon rupture happens suddenly. A rupture can be partial or complete.
What does a torn biceps tendon feel like?
Words or expressions I am listening for: 1) I heard a “pop” or had distinct pain in the front of my shoulder when this happened; 2) I’ve noticed pain, swelling, bruising, cramping in my arm since this happened; 3) It hurts to flex my elbow now. —Dr. Bradley Graw
Biceps tendon rupture usually happens in an instant. The result is immediate pain and weakness in the upper arm. Pain is usually worse when the palm is facing forward or up.
- Pain in the arm from the elbow up to the shoulder
- Weakness when you try flexing the arm
- Swelling and bruising anywhere from the elbow to the shoulder
- You may notice a bulge in your arm up toward the shoulder. This is a biceps muscle that got balled up once it was no longer attached.
Other symptoms you may have
- Numbness and tingling in the forearm that is worse on the thumb side, but this symptom is rare.
Causes of biceps tendon rupture
Your tendon can rupture if an unexpected stress on the arm strains the muscle, and the bands holding it to the bone break. Taking performance-enhancing (anabolic) steroids or smoking can reduce blood flow to the tendon, making it weaker and less able to handle weight. Trauma to the arm or having had surgery before can also reduce blood flow to the tendon.
Some competitive athletes have had this injury and decided against surgery without long-term repercussions. —Dr. Graw
If you experience severe pain that makes it hard to lift even small objects or use the arm, you should go to urgent care for an evaluation. This is so that a doctor can rule out any other reasons why you may have arm pain and weakness, such as a shoulder injury, a pinched nerve, or even a heart attack.
When these other causes are eliminated, you will be referred to an orthopedic surgeon for further evaluation—as there are other injuries that can mimic this—and treatment recommendations.
How do you treat a ruptured biceps tendon?
Ask your doctor: What do you see my long-term function being like after this injury? And at what point would you recommend surgery? —Dr. Graw
Your orthopedist will ask you a series of questions and do a physical examination of your arm. You will probably need an X-ray to make sure the bones are not injured. You should expect to go for an MRI scan to evaluate the muscle and tendon in your arm. Depending on how bad your symptoms are, you may also need a CT scan to rule out problems in your blood vessels.
If the tear is partial and not too severe, your doctor will probably recommend rest, ice or heat, and taking anti-inflammatory medications like ibuprofen (Advil) to relieve pain. They’ll also recommend physical therapy.
If you have a severe rupture, it is controversial whether surgical repair is necessary or not. Some studies show that nonsurgical treatments are effective in regaining your strength or function. However, you may have a cosmetic deformity where the biceps muscle is more prominent in the lower arm. Surgery can reduce this problem, and may improve the function of your arm, but this should be discussed with your surgeon.
If you have surgery, it should happen within days or weeks of when you first got hurt. That timing will depend on how severe the rupture is and how much swelling there is.
Surgery can be done in a few different ways. You should expect one or two incisions in your arm. During the operation, the muscle will be repaired and the tendon will be stitched, screwed, or pinned to the bone to hold it in place.
The doctor will then put your arm in a sling, so that you cannot move it after surgery. This holds the arm still and gives it time to heal. Physical therapy will be recommended to help you regain your strength and movement.
If you have surgery, you will have to follow up with your surgeon afterwards to make sure everything is healing correctly. You may need to have some stitches removed 10 to 14 days after the procedure.
You will also need physical therapy for several weeks to months, depending on how you are progressing and regaining strength. Smoking can prevent proper healing, so if you smoke, definitely speak to your doctor about ways to quit. There are nicotine pills, patches, or gum that can help break the cigarette habit.
There’s no way to stop a biceps tendon rupture from happening. But there are ways to make one less likely.
Ask your doctor why they think it happened to you. And whether you have any risk factors.
If you smoke, work on quitting. Don’t take performance-enhancing (anabolic) steroids. When strength training, avoid lifting heavy weights that are too much for your body.
Sourav Bose is a postdoctoral research fellow at the Center for Fetal Research in the Department of Surgery at the Children’s Hospital of Philadelphia and is a general surgery resident at the Brigham and Women’s Hospital affiliated with Harvard Medical School.
His current clinical investigation is in care programs for children with congenital anomalies and he is particularly interested in understanding how organizational structure and management influence patient outcomes and access to advanced precision care. He is also actively engaged in translational work investigating the efficacy of in utero gene therapy for congenital metabolic diseases. Previously, Sourav conducted and published research on pricing of healthcare services in Guatemala and Mongolia and on pediatric trauma outcomes.
Sourav received a BSc Economics from the Wharton School and a BA Biology from the School of Arts and Sciences through the Roy & Diana Vagelos Program in Life Sciences and Management at the University of Pennsylvania. He subsequently was awarded the Thouron Fellowship to pursue an MSc Public Health at the London School of Hygiene and Tropical Medicine. His master’s thesis evaluated the organizational and human resources investments necessary to conduct global clinical trials focusing on the Crash-2 investigative group. He returned to Penn where he received his MD from the Perelman School of Medicine and his MBA in Healthcare Management from the Wharton School.