Biceps Tendon Tear: Causes, Symptoms, and Treatment

What is a Biceps Tendon Tear?

The biceps tendon is a strong band of tissue that connects the biceps muscle to the shoulder and elbow. There are two main biceps tendons:

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

• Short Head of the Biceps Tendon: This tendon attaches at the front of the shoulder to the coracoid process (part of the shoulder blade) and does not pass through the shoulder joint.

A biceps tendon tear can occur in either of these tendons, but it most commonly affects the long head of the biceps tendon at the shoulder. A tear can range from a mild strain or partial tear to a complete rupture of the tendon.

Causes of Biceps Tendon Tear

A biceps tendon tear can result from a variety of causes:

1. Acute Injury

A sudden injury or trauma, such as a fall, direct blow, or lifting a heavy object, can cause the biceps tendon to tear. This type of injury is common in contact sports or activities that involve heavy lifting or sudden movements.

2. Degenerative Changes

Over time, tendons can become weaker due to aging or chronic overuse. People over the age of 40 are more susceptible to tendon tears, especially if they have been engaged in repetitive overhead motions (e.g., lifting, throwing, or swimming).

3. Overuse and Repetitive Strain

Repetitive stress on the shoulder or elbow, especially during activities like weightlifting, throwing, or overhead motions, can increase the risk of a tendon tear. Overuse can lead to tendon degeneration, making the tendon more prone to injury.

4. Sudden Force or Lifting

Lifting heavy objects suddenly or performing a jerking motion, particularly when the arm is extended or bent, can result in a tear. This is especially true if the biceps tendon is already weakened by previous injury or overuse.

Symptoms of a Biceps Tendon Tear

A biceps tendon tear can present with a range of symptoms, depending on the severity of the injury:

Common Symptoms Include:

• Sudden Sharp Pain: A tear may cause immediate sharp pain in the shoulder or elbow, often accompanied by a popping or snapping sound at the time of injury.

• Pain and Tenderness: Pain and tenderness are typically felt in the front of the shoulder or the elbow, depending on which tendon is torn.

• Decreased Strength: Individuals may experience significant weakness in the affected arm, making it difficult to lift, carry, or perform tasks that require elbow or shoulder strength.

• Bruising: Discoloration and swelling around the shoulder or elbow can occur, especially after an acute tear.

• Visible Deformity: In cases of complete rupture, the biceps muscle may "ball up" or form a noticeable bulge (often referred to as a "Popeye muscle") in the upper arm due to the muscle retracting away from the tear site.

• Difficulty Moving the Arm: Movements involving lifting, rotating, or extending the arm may become painful or limited due to the tear in the tendon.

• Tenderness at the Biceps Tendon Attachment: There may be localized tenderness at the area where the tendon attaches to the shoulder or elbow joint.

Diagnosing a Biceps Tendon Tear

Diagnosis of a biceps tendon tear typically involves a combination of a physical examination and imaging tests:

1. Physical Examination

During a physical exam, a healthcare provider will assess the shoulder or elbow for signs of a biceps tendon tear, including:

• Tenderness along the biceps tendon

• Weakness when performing shoulder or elbow movements

• A visible bulge (if the tear is complete)

• Special tests, such as Speed’s Test or Yergason’s Test, may be used to provoke symptoms and confirm the diagnosis.

2. Imaging Tests

• X-rays: While X-rays do not show soft tissues, they may help rule out bone fractures that could be contributing to the symptoms.

• MRI (Magnetic Resonance Imaging): MRI is the gold standard for diagnosing soft tissue injuries, including tendon tears. An MRI provides detailed images of the tendon, allowing the physician to assess the extent of the tear.

• Ultrasound: In some cases, ultrasound can be used to evaluate the biceps tendon in real time, especially for identifying partial tears.

Treatment for Biceps Tendon Tear

The treatment approach for a biceps tendon tear depends on the severity of the injury (partial vs. complete tear), the patient’s age, activity level, and overall health.

Non-Surgical Treatment Options

For partial tears or in cases where surgery is not immediately necessary, non-surgical treatment may be effective:

• Rest and Ice: Resting the affected arm and applying ice to the shoulder or elbow can help reduce pain and swelling in the initial stages after injury.

• Pain Relief and Anti-Inflammatories: Over-the-counter medications, such as ibuprofen or acetaminophen, can help manage pain and reduce inflammation.

• Physical Therapy: Physical therapy focuses on strengthening the muscles around the shoulder or elbow, improving range of motion, and enhancing overall function. Specific exercises may be prescribed to rehabilitate the biceps tendon and prevent further injury.

• Bracing or Splinting: In some cases, a brace or splint may be used to limit movement and provide support during the healing process.

Surgical Treatment Options

In more severe cases, such as when the tendon is completely torn or there is significant loss of function, surgery may be required:

• Biceps Tendon Repair: Surgical repair of the torn tendon involves reattaching the tendon to the bone. This can be done through traditional open surgery or minimally invasive arthroscopic surgery.

• Biceps Tenodesis: If the tendon is degenerated or the tear is chronic, a procedure called tenodesis may be performed, in which the tendon is removed from its original attachment site and reattached to a different part of the bone (usually the humerus).

• Tendon Grafting: In some cases, a tendon graft may be used to replace a damaged or missing part of the biceps tendon, particularly if the tendon is severely torn or atrophied.

Recovery and Rehabilitation

Recovery from a biceps tendon tear can take several weeks to months, depending on the severity of the tear and the type of treatment used.

• Phase 1: Pain Management and Rest: Initially, rest, ice, and pain medications are used to reduce inflammation and manage discomfort.

• Phase 2: Range of Motion and Stretching: As pain decreases, gentle range-of-motion exercises are introduced to maintain joint mobility and flexibility.

• Phase 3: Strengthening Exercises: Once the tendon has started healing, strengthening exercises are introduced to build muscle strength around the shoulder or elbow.

• Phase 4: Functional Training: Gradual return to normal activities, including sports or heavy lifting, is introduced as the tendon and muscles regain strength and flexibility.

Most people can expect to return to their normal activities after 3 to 6 months of rehabilitation, depending on the severity of the injury and the type of treatment.

Prevention of Biceps Tendon Tear

To prevent a biceps tendon tear, the following strategies can help protect the tendon:

• Avoid Overuse: Avoid repetitive movements that stress the shoulder and elbow, especially heavy lifting or overhead activities.

• Warm-Up Properly: Always warm up before engaging in physical activity, particularly activities involving the arms and shoulders.

• Strengthen the Shoulder and Arm Muscles: Regular strength training, especially targeting the shoulder, upper arm, and rotator cuff muscles, can help prevent injury and improve tendon resilience.

• Use Proper Technique: If participating in sports or weightlifting, ensure that proper form and technique are used to avoid unnecessary strain on the tendon.

Expert Care at Palms Physiotherapy & Allied Health

At Palms Physiotherapy & Allied Health, we offer expert physiotherapy services to help you recover from biceps tendon tears. Whether you are dealing with a partial tear, a complete rupture, or need rehabilitation post-surgery, our team is here to guide you through every step of the recovery process. With personalized treatment plans, physical therapy, and rehabilitation, we can help you regain strength, flexibility, and return to your normal activities.