Biceps Tendon Rupture: Types, Causes, Risk Factors, Symptoms, Diagnosis, Treatment, Exercise
Biceps Tendon Rupture results in pain and weakness of the shoulder and upper arm when proximal tendon is rupture. Biceps muscle participates in shoulder and elbow joint movements. The muscle is attached to both the joint. Muscle lies in front of elbow joint and upper arm. Weakness in bicep muscles affects shoulder joint and elbow joint flexion.
What Is Biceps Tendon Rupture?
- The muscle present in front of the upper arm is known as the Biceps Muscle.
- Proximal end of biceps has two head, which joins to form biceps muscles. The long head is attached to shoulder joint and short head originates at coracoid process of the scapula.
- The function of the proximal end of the biceps is to assist in flexion of upper arm at shoulder and stabilize the shoulder joint.
- Distal end of biceps is attached to radial tuberosity of radial bone. Biceps also assists in supination of forearm at elbow joint.
- Biceps also influences the stability of the shoulder and elbow joint.
- The tendon is a thick bundle of fibrous tissue, which connects muscles to bones.
- Rupture of the proximal biceps tendon causes painful flexion and rotation of upper arm at the shoulder joint.
- Rupture of distal end of biceps causes pain over the elbow joint. Patient is unable to supinate the forearm.
Types & Classification Of Biceps Tendon Rupture
Biceps Tendon Ruptures Are Of Two Types:
- Proximal Biceps Tendon Ruptures.
- Distal Biceps Tendon Ruptures.
Proximal Biceps Tendon Rupture And Distal Biceps Tendon Rupture Are Further Classified As:
- Partial Tears Of Biceps Tendon (Proximal and Distal): A partial tear is a tear in which the tendon is not completely torn out.
- Complete Tears Of Biceps Tendon (Proximal and Distal): A complete tear is a tear in which the tendon splits into two parts.
Causes of Biceps Tendon Rupture
There are usually two principle causes of Biceps Tendon Rupture and they are injury and overuse.
- Biceps Tendon Rupture Due to Injury: This happens in cases where an individual falls on the outstretched arms or when attempting to lift a heavy object.
- Biceps Tendon Rupture Due to Overuse: Biceps Tendon Rupture may also occur due to repetitive heavy lifting especially working in industries that require heavy lifting and over a period of time such people develop a Biceps Tendon Rupture. Any type of overuse can result in significant loss of range of motion as well as inflammation of the tendons, shoulder impingement, and rotator cuff problems.
Risk Factors For Biceps Tendon Rupture
Some Of The Risk Factors For Biceps Tendon Rupture Are:
- Age- tendon rupture is more often seen in older patients.
- Repetitive Activities- Individual involved in overhead manual work or sports needing repeated use of heavy objects results in biceps tendon rupture. Injury is observed in tennis player.
- Chronic Smoker- Smoking causes low oxygen carrying capacity in blood and often results in inadequate blood supply of the muscles.
- Corticosteroid- Corticosteroid injection near the tendon or daily consumption of corticosteroid pills causes degenerative weakness of the tendon and often results in rupture.
Symptoms Of Biceps Tendon Rupture
Biceps Tendon Rupture Symptoms Include:
- Pain- Pain is felt over upper part of the upper arm. The proximal biceps tendon rupture is more common than distal biceps tendon rupture. Pain is often sharp and excruciating pain.
- Audible Pop- Patient hears and feels pop when tendon is separated or ruptured.
- Bicep Muscle Cramp- Use of upper arm causes cramping of biceps muscle. Muscle cramp causes bulging of the muscles.
- Bruising- Muscle tear causes bleeding and collection of blood under the skin over the fractured site.
- Tenderness- Muscle adjacent to the fractured tendon is tender when examined and palpated.
- Weakness- Patient experiences weakness of the shoulder and elbow joint. Weakness is prominent when patient tries supination at the elbow joint. 1
- Shoulder Joint Movement- Patient finds it difficult to rotate the arms because of pain and lack of support from biceps muscles.
- Coiling of the Tendon- Prolonged untreated rupture biceps tendon results in coiling and forming a scar tissue.2
- Compartmental Syndrome- Rupture of distal biceps tendon rarely causes compartmental syndrome over the distal tendon near elbow joint.3 Compartmental syndrome is very painful condition and results in swelling and compression of blood vessels.
Diagnosis of Biceps Tendon Rupture
- Detailed history and physical examination suggest the area of pain and deformity.
- The flexion of elbow and shoulder joint movement often shows abnormal bulge of uncoordinated biceps muscles.
- If there is a complete rupture of the Biceps Tendon then there will be a deformity of the arm, which will confirm the diagnosis.
- Partial or incomplete ruptures are more difficult to diagnose. Physician may bend the arm during examination so as to tighten up the biceps muscle, which results in pain and abnormal bulge of muscles.
- X-ray- Apart from a physical examination, the physician will also order radiological studies in the form of x-rays to look at the shoulder and elbow joint to rule out fracture or dislocation.
- MRI- This is performed to evaluate soft tissue such as muscles and tendon. The tendon rupture is diagnosed with MRI studies.
Treatment For Biceps Tendon Rupture
Treatment for Biceps Tendon Rupture can be both conservative as well as surgical. Conservative approach is beneficial in healthy retired individual or young patients who are not involved in manual work. 3
Nonsurgical Treatment For Biceps Tendon Rupture:
- Cold and Ice Therapy- Application of ice for about 20 minutes every 3 to 4 hours helps to reduce pain and swelling.
- NSAIDs: Medications like Ibuprofen or Naproxen are beneficial to control pain and swelling.
- Activity Modification: Restriction of heavy lifting and other activities, which might aggravate the condition are also beneficial and allows the tendon to heal.
- Physical Therapy is also a very important aspect in treatment of Biceps Tendon Rupture as PT helps in restoring movement and regaining flexibility of the shoulders
Surgical Treatment For Biceps Tendon Rupture:
- Repair of Tendon- Surgical repair of tendon is performed immediately following injury. Tendon is isolated and reattached to radial tuberosity.
- Use of Graft- Coiled retracted and scarred tendon is often short and repair involves use of tendon graft. The surgery has indicated improved biceps function.4
Postsurgical Rehabilitation For Biceps Tendon Rupture:
- Post-surgery, the shoulder joint may need to be immobilized for some time by using a sling. Once the wounds have healed then the physician will start the individual on an exercise regimen to help regain the motion and flexibility of the shoulder.
A surgery for biceps tendon rupture usually results in complete recovery.
Exercises For Biceps Tendon Rupture
The following exercises are usually given to patients who have been treated for Biceps Tendon Rupture. A physical therapist should be consulted before starting with the exercises.
Elbow Bend to Straighten: To do this exercise, bend and straighten the elbow as far as it can be done without pain. Do this for about 10 times.
Flexion with Stick: Stand tall with the back and neck absolutely straight. Use a bar or stick to gently push the arm forwards and upwards as far as possible without pain. Do this for about 10 times.
Static Biceps Contraction: Keep the elbow at the side and bent at 90 degrees. Push up against the uninjured hand thus tightening the biceps. Hold for about 10 seconds and repeat about 10 times without increase in pain.
1. Treatment of chronic biceps tendon ruptures.
Dillon MT1, King JC2.
Hand (N Y). 2013 Dec;8(4):401-9.
2. Distal biceps rupture: the coil sign.
Austin L, Pepe M, VanBeek C, Tjoumakaris F.
Orthopedics. 2014 Jun 1;37(6):e605-7.
3. Distal biceps brachii tendon rupture resulting in acute compartment syndrome.
Grandizio LC, Suk M, Feltham GT.
Orthopedics. 2013 Nov;36(11):e1479-81.
4. When is a conservative approach best for proximal biceps tendon rupture?
Pugach S1, Pugach IZ.
J Fam Pract. 2013 Mar;62(3):134-6.