Biceps Tendon Rupture: Causes, Symptoms, and Treatment

What is a Biceps Tendon Rupture?

A biceps tendon rupture occurs when the tendon that attaches the biceps muscle to the bone either tears or completely detaches from the bone. There are two primary biceps tendons:

• Long Head of the Biceps Tendon: This tendon runs through the shoulder joint and attaches to the top of the shoulder blade.

• Short Head of the Biceps Tendon: This tendon attaches to the front of the shoulder blade and does not pass through the shoulder joint.

The rupture can occur in either tendon, with the long head of the biceps tendon being more commonly affected. When the tendon ruptures, the biceps muscle may "ball up" or form a noticeable lump in the upper arm due to the muscle retracting away from the torn tendon.

Causes of Biceps Tendon Rupture

A biceps tendon rupture can result from several factors:

1. Trauma or Acute Injury

A sudden, forceful injury or trauma is a common cause of tendon rupture. This can occur due to:

• Heavy lifting or jerking movements, especially when lifting a load suddenly.

• Falls or accidents that result in a direct blow to the shoulder or elbow.

• Overstretching or awkward positioning of the arm during activities such as sports or manual labor.

2. Degenerative Changes Due to Aging

With age, tendons naturally weaken and become more susceptible to tearing. This is particularly true for the long head of the biceps tendon, which is often exposed to chronic wear and tear. As a result, individuals over 40 years old are more likely to experience a rupture due to degeneration of the tendon over time.

3. Repetitive Overuse

Chronic overuse of the arm, especially in sports involving repetitive overhead motions (e.g., baseball, tennis, swimming) or manual labor, can increase the risk of tendon rupture. Overuse can lead to gradual wear on the tendon, making it more prone to rupture under stress.

4. Previous Tendon Injury or Condition

A person who has experienced a previous shoulder or elbow injury may be at higher risk for tendon rupture. Conditions such as shoulder impingement, rotator cuff injuries, or other tendonitis can increase the likelihood of a biceps tendon tear or rupture.

Symptoms of Biceps Tendon Rupture

The symptoms of a biceps tendon rupture can vary depending on the extent of the injury, but typical signs include:

Common Symptoms:

• Sudden Sharp Pain: A sudden, intense pain is often felt in the shoulder or elbow at the time of the rupture. This pain may be accompanied by a popping or snapping sound.

• Visible Deformity: One of the hallmark signs of a biceps tendon rupture is the appearance of a bulging mass or "Popeye muscle" in the upper arm. This occurs when the biceps muscle recoils or moves away from the rupture site.

• Weakness in the Arm: A ruptured tendon leads to significant weakness, particularly in activities requiring lifting or bending of the elbow. Tasks like lifting objects or pushing can become difficult due to the loss of biceps strength.

• Pain and Tenderness: Pain may persist in the shoulder or elbow, especially with certain movements. Tenderness can be felt in the front of the shoulder or elbow, depending on where the rupture occurs.

• Difficulty with Shoulder and Elbow Movements: A ruptured biceps tendon may make it difficult to fully extend or flex the elbow, and shoulder mobility may be reduced.

Diagnosing a Biceps Tendon Rupture

Diagnosing a biceps tendon rupture involves a thorough evaluation by a healthcare professional, often with the aid of imaging tests:

1. Physical Examination

During the physical examination, a healthcare provider will assess:

• Pain and tenderness at the biceps tendon attachment.

• Weakness in the arm when performing specific movements such as elbow flexion or shoulder rotation.

• Visible deformity or bulging of the upper arm (Popeye sign).

• Special Tests: Tests like the Speed’s Test and Yergason’s Test may be used to provoke pain and assess the integrity of the tendon.

2. Imaging Tests

• X-rays: Although X-rays cannot directly detect soft tissue injuries, they can help rule out fractures or other bone-related issues in the shoulder or elbow.

• MRI (Magnetic Resonance Imaging): MRI is the most accurate imaging method for detecting a biceps tendon rupture. It provides detailed images of soft tissues and allows for assessment of the tendon’s condition and the extent of the rupture.

• Ultrasound: An ultrasound may be used to evaluate the biceps tendon in real-time, particularly for partial ruptures or to monitor tendon healing during treatment.

Treatment for Biceps Tendon Rupture

Treatment for a biceps tendon rupture depends on the severity of the injury, the patient's activity level, and whether the tendon is fully or partially ruptured. Both non-surgical and surgical treatment options are available.

Non-Surgical Treatment

In cases of partial ruptures or when surgery is not immediately necessary, non-surgical management may be recommended:

• Rest and Ice: Resting the arm and applying ice to the shoulder or elbow can help reduce pain and swelling immediately following the rupture.

• Pain Relief: Over-the-counter pain relievers such as ibuprofen or acetaminophen can help manage pain and inflammation.

• Physical Therapy: A physical therapist will design an exercise program to improve range of motion, reduce pain, and strengthen the muscles around the shoulder or elbow. This rehabilitation program focuses on regaining function after the injury.

• Bracing or Sling: A sling or brace may be recommended to immobilize the arm and reduce strain on the tendon during the healing process.

Surgical Treatment

For complete ruptures or cases where there is significant weakness or dysfunction, surgery may be necessary to restore function:

• Biceps Tendon Repair: In this surgical procedure, the torn tendon is reattached to the bone. The repair can be done through open surgery or minimally invasive arthroscopic surgery.

• Biceps Tenodesis: If the tendon is severely degenerated or cannot be repaired, the surgeon may choose to perform a biceps tenodesis. This involves reattaching the tendon to a different location on the bone (usually the humerus), allowing the muscle to function without the need for the original attachment site.

• Rehabilitation after Surgery: After surgery, rehabilitation will involve a gradual return to movement and strengthening exercises. It may take several months for full recovery.

Recovery and Rehabilitation

Recovery time from a biceps tendon rupture depends on whether surgical or conservative treatment was used:

• Non-Surgical Recovery: Recovery can take several weeks to months. Initially, rest and pain management are crucial, followed by physical therapy to regain strength and mobility.

• Post-Surgery Recovery: After surgery, rehabilitation is often more intensive, involving a series of stages starting with rest and passive motion exercises, followed by strengthening exercises as the tendon heals. Complete recovery may take up to 6 months or longer, depending on the severity of the rupture.

Prevention of Biceps Tendon Rupture

To help prevent a biceps tendon rupture, consider the following strategies:

• Warm Up Properly: Always warm up before engaging in physical activity to reduce the risk of injury.

• Strengthen the Biceps and Shoulders: Regular strength training focusing on the biceps, shoulder muscles, and rotator cuff muscles can improve tendon resilience and reduce the risk of injury.

• Use Proper Form: Whether lifting weights, playing sports, or performing any strenuous activity, maintaining proper form is essential to reduce stress on the tendons.

• Avoid Overuse: Avoid repetitive overhead movements or excessive lifting without rest to give tendons time to recover.

Expert Care at Palms Physiotherapy & Allied Health

At Palms Physiotherapy & Allied Health, our experienced physiotherapists specialize in the diagnosis and treatment of biceps tendon ruptures. Whether you're seeking non-surgical rehabilitation or post-surgery recovery, our team provides personalized care to help you regain strength and function. We offer comprehensive rehabilitation services designed to restore mobility and strength, so you can get back to the activities you enjoy.