Introduction
Biceps tendons help attach the biceps muscles to the shoulder and elbow bones. When a tear occurs in the shoulder tendon, the arm loses its strength and has pain during forceful movement of the arm during palm up and palm down. However, most people still function at a high level with a shoulder tendon tear and require only simple treatment to relieve pain.
What Is the Anatomy of the Biceps Tendon?
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The shoulder is a ball and socket joint made up of three bones- the upper arm bone, shoulder blade, and collar bone.
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The head of the upper arm bone fits into the rounded socket in the shoulder blade. This is called the glenoid socket.
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The muscles and ligaments (connect bone and muscles) are called rotator cuffs- keep the arm bone centered in the shoulder socket and attach it to the shoulder blade.
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The upper end of the biceps muscle has two tendons that help in attachment to the shoulder bone.
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The long head attaches to the shoulder socket, whereas the short head attaches to the bump on the shoulder blade.
What Are the Types of Biceps Tears?
Partial Tear: Partial tears will not completely sever the tendon.
Complete Tear: The complete tear will split the tendon into pieces.
Why Is the Biceps Tendon More Likely to Be Injured?
The biceps tendon is more vulnerable as it travels through the shoulder joint to the attachment point in the socket. The short head of the biceps tendon rarely tears because of the second attachment. Even though the long head of the biceps tendon tears completely, the person can use the biceps.
What Are the Causes?
The First cause that mostly cause this condition is injury. Falling on a hard outstretched arm and lifting something too heavy results in a biceps tear. Another cause of this condition is overuse of the biceps tendon. Aging results in the wearing down and fraying of the tendon. It can be worsened by overuse.
What Are the Risk Factors?
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Age: Older people are more prone to wear and tear tendons.
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Overhead Activities: Too much load during weight lifting causes excess wear and tear on the tendons
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Shoulder Overuse: Sports like swimming and tennis cause wear and tear on the shoulder tendons due to repetitive actions.
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Smoking: Smoking causes weakness of the tendon.
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Corticosteroid Injection: Corticosteroid injections cause muscle and tendon weakness.
What Are the Symptoms?
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Sharp pain in the upper arm.
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Pain is of sudden onset.
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Audible popping sound.
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Cramping of the biceps muscle.
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Pain and tenderness of the shoulder and elbow.
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Difficulty in turning the hand.
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A bulge in the upper arm above the elbow.
How to Diagnose?
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A thorough medical history is obtained by the physician before examining the person.
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To diagnose the partial ruptures, the physician will ask to bend the arm and tighten the biceps muscle. The presence of pain indicates a partial tear.
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The biceps tear may also occur near the elbow, which causes a gap in front of the elbow. The physician will check the arm for damage to this area.
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The provocative tests include the hook test and Ruland biceps squeeze test.
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In the hook test, the physician will use the index finger to hook around the lateral edge of the biceps tendon with the elbow flexed and in the supination position.
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If the physician can hook the finger one centimeter underneath the tendon, then the test is positive, and the tendon is intact.
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In the Ruland biceps squeeze test, the elbow is supported in sixty to eighty degrees of flexion, and the forearm is downward. The physician will squeeze the distal biceps muscle belly. The test is positive when there is no supination (facing upward) of the forearm and wrist.
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Other investigations include X-rays and magnetic resonance imaging.
What Is the Treatment?
Non-surgical Treatment:
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Rest: Should take proper rest to relieve pain and swelling. Physicians may recommend using a sling to avoid pressure on the arm.
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Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Anti-inflammatory drugs like Ibuprofen can reduce pain which should be taken under physician advice.
- Physical Therapy: Once the individual recovers from pain, the physician recommends rehabilitation exercises to strengthen the muscles and restore function and movement.
Surgical Treatment:
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Surgery should be done during the first two to three weeks after the injury whereas three weeks after injury, the tendon and biceps muscle begin to scar and shorten, and it is impossible to restore the function through surgery.
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The aim of the procedure is to reattach the distal biceps tendon to the forearm bone.
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The procedure involves an incision on the front of the elbow and sometimes an incision placed on the front and back of the elbow.
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One method to attach the tendon is with stitches through holes drilled into the radius bone. Another method is using small metal implants.
What Are the Complications of Surgery?
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Numbness and weakness in the forearm, wrist, and hand can occur, which usually goes away.
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New bone formation occurs around the site where the tendon is attached to the forearm bone, which causes a limitation of movement and reduces the ability to twist the forearm.
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Rupture of the tendon may occur even after full healing.
When to Start Rehabilitation Exercises?
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Soon after surgery, the individual's hand is stabilized with a splint or cast.
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The physician will soon start with the movement of the arm with the protection of the brace.
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Physicians also prescribe physical therapy to regain the range of motion and strength.
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Rehabilitation exercises are added gradually, which include the use of elastic bands and contracting the biceps lightly.
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Usually, biceps tendon tears take three to four months to heal; the individual must follow the physician's advice.
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Light activities can be started after surgery, while lifting heavy objects should be avoided for several months.
What Is the Outcome of the Surgery?
Almost all individuals will perform a full range of motion and strength at the final doctor visit. After a period, the individual can resume their regular activity and jobs.
Conclusion
The key to preventing this injury is to educate the individual on modifying the risk factor, such as discontinuation of smoking and stretching before physical activity. Once the injury is diagnosed, work-specific and sport-specific training is recommended before resuming their regular activity. The complete recovery occurs within eight to twelve weeks.
