What is the biceps tendon?
The biceps tendon is a strong rope-like structure that attaches the biceps muscle to the shoulder and the elbow. The biceps muscle helps to lift your arm, bend your elbow, and rotate your forearm to turn the palm up. Biceps tendons can rupture or tear at the shoulder or the elbow from overuse or injury. A biceps tendon at the elbow is called the distal biceps tendon.
The tear may be partial or complete. When partially torn, the tendon remains attached to the bone. When the tendon is torn off the bone it is called a complete tear. With a distal biceps tendon rupture, the tendon is torn away from the bone.
A biceps tendon tear at the shoulder can result from sudden injuries like a fall on an outstretched arm or twisting the elbow or shoulder; or from age and overuse that weakens and frays the tendon causing tendinitis, impingement, and rotator cuff injuries. Overuse injuries include overhead sports like swimming, tennis and throwing sports. Symptoms include pain, swelling and bruising, weakness, and reduced range of motion.
Generally, people who suffer a biceps tendon tear at the shoulder may have weakness and pain, but they can often function normally, and require only conservative management to relieve symptoms. If conservative management fails to relieve symptoms, surgery to repair the tendon may be recommended.
Dr. Patel will review your medical history, ask about your symptoms and how the injury occurred. He will conduct physical exam including strength testing and other provocation tests, and order imaging studies including x-rays to evaluate bones, and an MRI to evaluate the soft tissues including rotator cuff tendons. Often other shoulder injuries may occur along with a biceps tendon tear.
A complete tear of the biceps tendon cannot heal itself. It requires surgery to reattach the tendon to bone. Partial tears may ultimately require surgery. However, surgery may not always be required particularly if the tear is proximal or on the shoulder side. The decision to pursue surgery depends on the patient’s desire to return to sports and activities that make life enjoyable, and for those who perform repetitive activities involved in labor and construction, where activities like turning a screwdriver are important.
For shoulder tears, non-surgical management may be adequate to relieve symptoms in most patients. However, conservative treatment can lead to problems with cosmesis and cramping. Surgery for a shoulder tear is usually reserved for patients wish to not have any of the potential problems listed above.
Partial tears of the distal tendon may initially be treated with conservative management including a period of rest, bracing and activity modification and steroid injections. Tears that involve less than 50% of the tendon can be successfully treated with conservative management. Tears of more than 50% of the tendon are likely to fail conservative management and would benefit from surgical repair. Surgery can restore function and with therapy restore strength. The risk of retearing is low.
A complete tear of distal biceps tendon requires surgery to restore function. Patients who need the ability to rotate the palm up for work or sports often choose surgery even when the tear is partial.
A distal biceps repair is where the tendon is reattached to the bone. This surgery should be done in a timely fashion to prevent retraction of the tendon. Acute repair, within a week or two of the injury is the best option. A delay in surgical repair can complicate repair surgery, and even cause permanent muscle degeneration (atrophy).
Arthroscopic surgery to repair a complete tear of the biceps tendon is an outpatient procedure, performed with minimal incisions and minimal damage to surrounding structures. Complete healing can require three months of physical therapy but provides restoration of full range of motion and virtually normal strength.
Dr. Ronak M. Patel is a double board-certified orthopaedic surgeon and sports medicine physician. He completed his bachelor’s degree, medical degree, and residency training at Northwestern University. He, then completed his fellowship training at the Cleveland Clinic. He specializes in the treatment of complex knee, shoulder and elbow injuries and degenerative conditions. Contact him to schedule a consultation to learn more about how he can help you return to the life you love and the activities that make life worth living. He serves teens and adults in Chicagoland and NW Indiana.
At a Glance
Ronak M. Patel M.D.
- Double Board-Certified, Fellowship-Trained Orthopaedic Surgeon
- Past Team Physician to the Cavaliers (NBA), Browns (NFL) and Guardians (MLB)
- Published over 49 publications and 10 book chapters
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