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Tears in the bicep muscle are uncommon but serious injuries that can result in significant arm weakness. Tears can be partial, where the tendon is damaged, or complete, where the tendon completely detaches from the bone. The bicep is the muscle in the front of your upper arm, and it is supported by tendons that attach to the bones of the shoulder and elbow. Tears can occur at either of these attachment points, and while nonsurgical treatments are available, surgery is often required to reattach the tendon to the bone and restore full arm strength and function.
How to repair the bicep muscle
| Characteristics | Values |
|---|---|
| Bicep tendon tears | Can be partial or complete |
| Causes | Injury, overuse, aging, smoking, anabolic steroid use, local corticosteroid injection |
| Symptoms | Pain, mild arm weakness, muscle deformity, residual cramping, fatigue, bruising, tenderness |
| Treatment | Non-surgical treatment (rest, physical therapy, NSAIDs), surgery (single-incision, two-incision, biceps tenotomy) |
| Recovery time | Varies; typically 6 weeks to a few months, up to 4-5 months for normal activities |
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What You'll Learn
Surgical repair of the bicep tendon
Surgical repair of the biceps tendon is generally recommended for tears in the tendon, which can result in significant arm weakness. Surgery is usually performed within the first 2 to 3 weeks after injury, as delaying surgery can lead to chronic weakness. After this time, the tendon and biceps muscle begin to scar and shorten, making it difficult to restore arm function.
There are two main types of surgery for repairing a torn biceps tendon: open surgery and arthroscopic surgery. Biceps tenodesis, a type of open surgery, is performed to treat tears in the long head biceps tendon, which is located at the top of the bicep muscle. It involves cutting the biceps tendon from the labrum (cartilage in the shoulder socket) and, in some cases, relocating the tendon to the upper arm bone (humerus). Biceps tenotomy is an alternative procedure where the tendon is cut from the labrum but not reconnected to the upper arm bone. However, this procedure is associated with a higher risk of developing unusually large bulges in the biceps.
Arthroscopic surgery, on the other hand, utilises an arthroscope to visualise the biceps tendon and labrum. Small surgical tools are then used to detach the tendon from the labrum, and a small hole is drilled in the upper arm. The surgeon will then close the tiny cuts made during the procedure.
There are also different approaches to reattaching the distal biceps tendon to the forearm bone. The single-incision technique involves making one incision at the front (inside) of the elbow, while the two-incision technique uses small incisions at both the front and back (outside) of the elbow. Both techniques have comparable outcomes in terms of improved function and minimal pain and disability at two years.
After surgery, the arm is usually immobilised in a cast or splint, and physical therapy may be prescribed to help regain range of motion and strength. Light activities can be resumed soon after surgery, but heavy lifting and vigorous activity should be avoided for several months. The biceps tendon takes more than 3 to 4 months to fully heal, and full recovery can take up to 6 months.
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Nonsurgical treatment options
There are nonsurgical treatments that may help a partially torn tendon. Nonsurgical treatment focuses on relieving pain and maintaining as much arm function as possible. Treatment recommendations may include rest and avoiding heavy lifting and overhead activities to relieve pain and limit swelling. A doctor may recommend using a sling for a brief period. Anti-inflammatory drugs like ibuprofen and naproxen can help reduce pain and swelling.
After the pain decreases, a doctor may recommend rehabilitation exercises to strengthen the surrounding muscles and help restore movement and function. Physical therapy can improve the range of motion in the shoulder and strengthen the shoulder. Proximal biceps tendon ruptures can be treated conservatively with physical therapy and anti-inflammatories.
While surgery is the best option for restoring a completely severed tendon, nonsurgical treatment can be considered in the first 2 to 3 weeks after injury to avoid tendon scarring and shortening. Without surgery, there is a significant probability that the function of the injured extremity will be limited, with a 30 to 40% decrease in strength.
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Recovery and rehabilitation
If surgery is required, it should ideally be performed within two to three weeks of the injury to avoid tendon scarring and shortening. Following surgery, you will need to wear a sling or immobilize your arm in a splint or cast for four to six weeks. The recovery time varies but can be anywhere from six weeks to a few months, and in some cases, it can take four to five months before returning to normal activities.
Rehabilitation following surgery is a phased progression, with avoidance of premature stress to the healing soft tissue repair. The rehabilitation program aims to restore full arm strength and function, which can be achieved through physical therapy.
It is important to complete the recommended rehabilitation program to reduce the risk of re-tearing the tendon, which can occur in rare cases (about 1-2% of cases) if patients return to heavy lifting too quickly.
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Causes of bicep tears
Bicep tears are uncommon and are usually caused by a sudden injury. However, there are several factors that can increase the likelihood of a bicep tear.
The bicep muscle has two tendons that attach it to the shoulder and one tendon that attaches it to the elbow. The tendon at the elbow is called the distal bicep tendon. A distal bicep tendon tear will result in a complete tear, with the entire muscle detaching from the bone and pulling towards the shoulder. This type of tear is usually caused by the elbow being forced straight against resistance.
The two attachments of the bicep tendon at the shoulder joint are the long head and the short head. The long head attaches to the top of the shoulder socket (glenoid), and the short head attaches to a bump on the shoulder blade called the coracoid process. The short head rarely tears, and because of this second attachment, most people can still use their bicep muscle even after a complete tear of the long head.
Bicep tears can be caused by several factors, including injury, overuse, age, and smoking. Sports that require repetitive movements of the bicep in the shoulder or elbow, such as swimming, tennis, and throwing, can cause tears. Falling on an outstretched arm or lifting something too heavy can also result in a tear. Over time, tendons can wear down and fray, increasing the likelihood of a tear. This natural degradation of tendons occurs as we age and can be exacerbated by smoking, as nicotine weakens tendons.
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Diagnosis of a bicep tear
A bicep tear, also known as a bicep rupture, is a tear or break in the tendon that connects the biceps muscle in the upper arm to the shoulder or elbow. Tears of the biceps tendon at the elbow are uncommon and are usually caused by a sudden injury, while tears at the shoulder are often the result of a fall on an outstretched arm or lifting something too heavy.
In some cases, additional tests may be required to confirm the diagnosis. These tests can include an X-ray to check for bone fractures or bone spurs, which can cause tendon tears, and a magnetic resonance imaging (MRI) scan to create detailed images of the soft tissues, muscles, and tendons in the affected area. An MRI scan can provide valuable information about the extent of the tear and help determine the best course of treatment.
The treatment for a bicep tear will depend on the severity of the injury, the patient's lifestyle, and their individual needs. In general, bicep tears are classified as grades 1-3, with grade 1 being a minor injury with no loss of strength or mobility, grade 2 involving moderate tearing with some loss of mobility or strength, and grade 3 being a complete rupture of the muscle or tendon. For less severe tears, non-surgical treatments such as rest, ice, anti-inflammatory medications, and physical therapy may be recommended. However, for more severe tears, surgery may be necessary to reattach the tendon and restore full arm strength and function.
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Frequently asked questions
A bicep tendon tear is when one of the tendons that attach the bicep to the shoulder or elbow tears. Tears can be partial, in which the tendon is damaged, or complete, in which the tendon completely detaches from the bone.
Nonsurgical treatments include rest, physical therapy, and anti-inflammatory drugs like ibuprofen and naproxen. If the tear is more severe, surgery may be required to reattach the tendon to the bone.
Recovery time depends on the severity of the tear and the type of treatment. Even mild injuries can take at least two months to heal, and it can take four to five months before returning to normal activities.
