A therapist testing the strength of a man's bicep.

Biceps Tendon Rupture: Shoulder & Elbow Tendon Ruptures

The biceps muscle has two tendons, one attaching the muscle to the shoulder and the other at the elbow. The tendon at the elbow is a distal biceps tendon and proximal biceps tendon, each of which can suffer a rupture. Each tendon, due to the nature of its function, has different treatment options and symptoms, but both types of biceps tendon rupture require medical intervention to ensure proper use and strength return.

Tendon Rupture in Biceps Overview

Both types of biceps tendon ruptures can be either partial or complete tears, often beginning as a fraying tendon that progresses to a tear:

  • Partial tears: Usually described in terms of how deep the tear is in the tendon and don’t refer to length, width, or other dimensions
  • Complete tears: The tendon has split/severed into two pieces

For a distal biceps tendon rupture (elbow), the other arm muscles can usually compensate for the injured tendon and allow the arm to maintain full motion with reasonable function. For proximal biceps tendon ruptures (shoulder), the long head of the biceps tendon is more likely to be injured due to it traveling through the shoulder joint. As there are two tendons (short and long head), most people can still use their biceps even after a complete tear of the long head.

Bicep Rupture Symptoms & Causes

For both distal and proximal biceps tendon ruptures, there are two main causes:

  • Injury: For ruptures at the shoulder, an outstretched arm or lifting something too heavy can tear the biceps tendon. If the tendon at the elbow ruptures, it is usually from when the elbow is forced straight against resistance or forcibly bent against a heavy load.
  • Overuse: While a distal tendon rupture in the biceps doesn’t occur from overuse, it does at the shoulder. When a tendon rupture occurs at the shoulder it is gradual, resulting from wearing down and fraying over time. This especially happens with other shoulder overuse conditions, such as shoulder impingement, rotator cuff injuries, or tendinitis.

When a biceps rupture occurs in the elbow tendon, there is often a pop and then severe pain which can subside after a week or two, with other symptoms that include:

  • Swelling in the front of the elbow
  • Clear bruising in the elbow and forearm
  • Weakness when bending the elbow
  • Weakness when twisting the forearm
  • A gap in the front of the elbow
  • A bulge in the upper part of the arm

When a biceps tendon ruptures in the shoulder, symptoms generally include:

  • A clear pop or snap sound
  • Sudden and sharp pain in the upper arm
  • Cramping in the biceps muscle
  • Bruising in the middle of the upper arm, toward the elbow
  • Weakness in the shoulder and elbow
  • Pain in the shoulder and elbow
  • A bulge in the upper arm above the elbow with a dent closer to the shoulder

Diagnosis & Treatment

Diagnosing a biceps tendon rupture, in either area, follows a similar process. The healthcare provider will discuss your symptoms and how the injury occurred, examining the elbow or shoulder by:

  • Feeling the front of the elbow, looking for a gap in the tendon
  • Testing the strength of the forearm by having you rotate it against resistance, doing the same with the uninjured arm to compare them.
  • Tightening the biceps to see if there is pain
  • Imaging tests, such as an X-ray to rule out other potential causes, and an MRI to see what type of tear occurred

While surgery is required for a biceps rupture at the elbow, nonsurgical treatments are first used for a rupture at the shoulder:

  • Icing the area for 20 minutes at a time, several times a day
  • Nonsteroidal anti-inflammatory drugs, such as ibuprofen, to reduce pain and swelling
  • Resting the affected arm and avoiding heavy lifting and overhead activities
  • Using a sling temporarily
  • Physical therapy, using flexibility and strengthening exercises to restore movement and strengthen the shoulder

Surgery is rarely needed for biceps rupture at the shoulder, usually reserved if symptoms don't ease with nonsurgical treatments. When surgery is recommended, it's to repair the tendon with minimal incisions and re-anchor the torn tendon back to the bone. There are several surgeries available to accomplish this.

 

For biceps tendon rupture at the elbow, surgery is required and usually performed during the first two or three weeks after the injury to ensure no scarring or tendon shortening occurs; if the tendon begins to shrink or scar, the arm may not return to full function even with surgery. The most common surgical approach is to attach the tendon with stitches through holes drilled into the radius bone or using small metal implants to attach the tendon.

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