Posted on January 13th, 20231/13/23
You’ve decided to commit to getting healthy by getting back in the gym. It’s been a while since you weight-trained, but you aren’t concerned. The exercise feels good, and your muscles burn while you curl a heavy barbell. On your fourth rep, you hear a sudden loud “pop” and feel sharp pain in the arm holding the weight. You drop the barbell and grasp your injured arm to support it. What happened?
MOSH has complete care and rehabilitation treatment plans for any type of orthopedic injury, including bicep tendon tears. To understand what just happened, you need to understand your arm’s basic anatomy and the injuries it can sustain.
Proximal Bicep Tendon Tears at the Shoulder
Tendons attach muscle to bone. Torn bicep tendons at the shoulder are called proximal bicep tears. They involve the long-head tendon (which attaches the bicep to the shoulder socket) or the short-head tendon (which connects the bicep to the shoulder blade). 96% of bicep tendon ruptures happen to the long-head tendon. Only 1% involve the short-end tendon.
- An injury to the long-head tendon is more likely from overuse and repetitive motions that fray the tendon or from a sudden, acute injury, like a fall. Athletes who throw overhead and jobs that require excessive heavy lifting or overuse of the shoulder are particularly susceptible to these injuries. Bicep tendon injuries are common in sports like tennis, swimming, weightlifting, baseball, and football.
- An injury to the short-head tendon is much less likely, and a non-injured short-head tendon may help compensate for a damaged long-head tendon. Short-head tendon tears are often part of a rotator cuff tear or other shoulder injuries.
In the event of either of these ruptures, you may still be able to use your arm, and your pain may decrease within a few days, even with partial tears.
Distal Bicep Tendon Tears at the Elbow
A tear in the distal bicep tendon means the tendon attaching the bicep to the elbow is damaged. A full range of motion is still possible because other muscles will compensate. Distal bicep tendon ruptures happen to 3 to 5 people per 100,000 a year and primarily to men over thirty. Most injuries are caused by catching or lifting a heavy item during athletic events or manual labor.
You will likely either have a shoulder (proximal) or elbow (distal) tendon tear. It is very rare to have both at the same time.
Types of Bicep Tendon Tear Injuries
Three rupture injuries can occur to the tendons of the biceps:
- A partial bicep tendon rupture means some of the tendon is still attached to the bone, or the muscle is fully attached, but the tendon is badly damaged.
What should you do now? If you suspect a bicep tendon tear, follow these steps to learn what to do and how MOSH can help.
Step 1: Assess Your Signs and Symptoms
Bicep tendon tear symptoms depend on the tendons affected and the severity of the injury. Signs and symptoms of an injury to either location can include:
- Pain, sometimes sharp and sudden, in your arm.
- A “popping” noise, usually near the elbow.
- Bruising and swelling near your elbow or shoulder.
- Inability to rotate your hand from palm down to palm up.
- Trouble moving your elbow, hand, arm, or shoulder.
- A warm sensation at the injury site.
- Weakness in the shoulder, arm, or elbow; a feeling of lost strength.
- Muscle cramping or twitching.
- A bulge in your upper arm called a Popeye deformity (the bicep has become detached from your elbow and is in a ball under your shoulder).
- A gap or depression near the front of your elbow.
Suspecting a bicep tendon tear also involves a basic understanding of your arm’s anatomy. The bicep muscle is on the front of the upper arm. The bicep’s primary purpose is to bend the elbow and help the forearm turn your hand from palm down to palm up.
Step 2: See a Doctor
Tendons do not reattach themselves. Whether you have a partial or complete bicep tendon tear, or tendonitis and inflammation from overuse, you need to see an orthopedic specialist like the doctors at MOSH.
How Are Bicep Tendon Tears Diagnosed?
The first thing your physician will do is get a medical history. They will want to know other injuries you may have had, the details surrounding your current injury, and the types of activities you do to check for risk factors.
Secondly, your doctor will perform a physical examination to determine external signs and symptoms of a bicep tendon tear or another injury. They may test your range of motion, strength, and which movements cause pain or discomfort.
Your doctor will need to perform imaging tests of the injury with an X-Ray, ultrasound, or an MRI scan (magnetic resonance imaging.)
Once the physical examination and imaging is complete, your doctor will diagnose your injury and provide you with a treatment plan and options for repairing the tendon.
Step 3: Follow Your Treatment Plan
Once a doctor has determined what the problem is, they will recommend surgical or non-surgical treatment plans based on the severity of your injury, your age, your tolerance to discomfort and your other needs. For example, if you are an older person with a small tear in one of the shoulder tendons, you might choose a non-surgical treatment because you are okay with reduced function in your arm and aren’t in any need to get back to intense activities. On the other hand, an athlete with a small shoulder tear may choose surgery to ensure function and strength recovery so they can continue in their sport.
Non-Surgical Treatment Options for a Bicep Tendon Tear
Many people have a high level of function with shoulder tendon tears and can consider non-surgical treatments for symptom management. Surgery may be beneficial if:
- Non-surgical interventions don’t relieve symptoms.
- You have intolerable muscle pain or cramping.
- You need full strength in your arm.
- You have lost significant arm function.
For tendonitis or a small or partial tear, non-surgical treatment options include:
- A modification in activities.
- Over-the-counter medications like non-steroidal anti-inflammatories (NSAIDs).
- Braces or slings.
- Rest or immobilization.
- Cold therapy (icing the affected areas with cold packs).
- Platelet Rich Plasma therapy (PRP).
- Physical therapy.
Surgical Treatment Options for Shoulder Tendon Tears
Surgery is a common and safe option as well. Surgery will likely be the first recommendation for a distal bicep tendon injury at the elbow, and is also recommended if:
- Non-surgical options aren’t relieving symptoms.
- More than 50% of your tendon has ruptured.
- The tendon tear is complete.
- The tendonitis has become problematic or doesn’t improve after a year.
A distal tendon tear is usually complete and is likely to require surgery to repair and reattach the bicep to the elbow. Without surgery, the affected arm can have a 30% to 40% decrease in strength. Surgery to fix a partial or complete tear needs to be done within the first 3 weeks of the injury. Scar tissue can develop on the bicep and tendon and shorten their lengths, which will make restoring full function to the arm difficult at best.
Recovery times for surgery vary, but usually you can return to your normal activities in four months. You will likely also need physical therapy to regain full function. Complete recovery can take anywhere from four months to one year.
Step 5: Learn Risk Factors And Prevention Methods
The best way to prevent bicep tendon ruptures is to be aware of the amount of resistance you are putting on the bicep as well as the elbow and shoulder joint. Other prevention tips entail:
- Maintaining strength and flexibility in the arm.
- Using caution when lifting or lowering heavy objects.
- Smoking cessation.
- Warming up before heavy bicep use, especially in activities that involve raising the arm above the head or repetitive elbow or shoulder use.
- Avoiding the use of anabolic steroids.
- Gradually increasing the intensity of new activities.
- Using proper form and equipment when performing activities, fitness routines, or playing sports.
Bicep tendon tears can happen at the elbow or the shoulder. Not all bicep tendon ruptures are serious, and some can be managed with non-invasive therapies. If you suspect a bicep tendon tear, consult with one of our orthopedic specialists as soon as possible. MOSH offers state-of-the-art surgical and non-surgical treatment options and experienced orthopedic rehabilitation teams. Contact us at 414-817-5800, or visit the Performance Center Clinic, our premier orthopedic care with convenient walk-in appointments.
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Filed under: Orthopedics, Shoulder
MUSCLES, TENDONS AND BONES
Go to a hospital emergency room immediately if there is severe, constant (intractable) pain associated with moving or bearing weight and there is a large bump or other physical deformity.
If you suspect a torn biceps, the first thing you need to do is visit a doctor for a diagnosis. Your doctor (preferably an orthopedist) will need to use an imaging test like an MRI to confirm a tear or rupture, although an X-ray may also be needed to rule out any injury to bone.Is a torn bicep tendon an emergency? ›
Distal biceps tendon ruptures almost always need urgent surgical repair as the patient may lose significant functioning of the affected arm .Is a torn tendon a medical emergency? ›
If you tear or rupture a tendon or ligament, you should seek medical attention as soon as possible. Your doctor needs to see how severe the injury is before it starts to swell. Swelling makes these injuries harder to diagnose.How urgent is a torn bicep? ›
Bicep tendon tears can be serious, but many respond to nonsurgical treatment, such as rest and physical therapy. If you think you might have injured your bicep tendon, see a doctor as soon as possible. Getting a diagnosis and treatment early can help you recover more fully.When is it too late to repair a torn bicep tendon? ›
Surgery to repair the tendon should be performed during the first 2 to 3 weeks after injury. After this time, the tendon and biceps muscle begin to scar and shorten, and it may not be possible to restore arm function with surgery.Do you need an MRI for a torn bicep? ›
Before you can tell that you have a bicep tear at your elbow, you need to be diagnosed first with an MRI (magnetic resonance imaging). An MRI is an imaging test that takes detailed pictures of what's inside your body through the use of powerful magnets and radio waves.Does a partially torn bicep tendon require surgery? ›
Partial tears <50% may be treated with nonoperative management or with surgical debridement of the surrounding synovitis. Tears >50% should be treated with division of the remaining tendon and surgical repair of the entire tendon as a single unit.Can you move your arm with a torn bicep tendon? ›
The biceps muscle has two tendons, one of which attaches it to the bone in the shoulder and the other attaches at the elbow. The biceps tendon at the elbow is called the distal biceps tendon and if there is a tear in this tendon, you will be unable to move your arm from the palm-down to palm-up position.How do you test for a torn bicep tendon? ›
A biceps tendon tear is made more obvious by contracting the muscle ("Popeye Muscle"). Partial ruptures are less obvious. To diagnose a partial tear, your doctor may ask you to bend your arm and tighten the biceps muscle. Pain when you use your biceps muscle may mean there is a partial tear.
Symptoms of a biceps tear or biceps rupture
Severe pain that may go away after a few days. Bruising and sometimes swelling in that part of the arm. Shoulder and arm weakness. A bulge in one part of the upper arm – with a gap in the other part – because the muscle has bunched up in one section of the biceps.
Symptoms of bicep tendon injuries can include pain at the injury site or throughout the arm, swelling, bruising, warmth to the touch, and a popping sound at the time of injury. Bicep tendon injuries also can include difficulty turning the arm and increased fatigue of the arm during activity.Do I need to go to the hospital for a torn tendon? ›
Get advice from 111 now if:
it's very painful, or the pain is getting worse. there is a large amount of swelling or bruising, or the swelling or bruising is getting worse. it hurts to put weight on it. it feels very stiff or is difficult to move.
If your strain is mild or moderate, you should be able to treat it at home using ice, heat and anti-inflammatory medication; however, more severe strains (or tears) typically need medical attention.What can the hospital do for a torn ligament? ›
The surgery will depend on the type of injury. For example, for a knee injury such as an anterior cruciate ligament (ACL) tear, a surgeon may remove the damaged ACL and replace it with tissue to grow a new ligament in its place. After surgery, patients are advised to do physical therapy to help with recovery.When should I go to the doctor for a torn bicep? ›
If you are experiencing any discomfort, an ache that travels down the upper arm, or if you have heard a snapping sound, then it is recommended that you visit a physician. If you do, he or she will ask questions regarding your medical history. Your doctor will then conduct an examination of your shoulder.Which bicep tendon is most likely to rupture? ›
The majority of biceps rupture involves the long head. Distal biceps tendon rupture can be complete avulsion or partial detachment from the lateral side of the radial tuberosity.Is bicep tendon surgery outpatient? ›
What to expect from biceps tendon surgery. Surgical tendon repair usually takes place in an outpatient setting. You can go home the same day as the procedure.Is bicep tendon surgery worth it? ›
Surgeons seem to agree that the benefit of surgery is a little more supination strength, with flexion strength returning close to normal with or without surgery. An untreated rupture causes less deformity than with proximal biceps rupture. Surgery adds a scar and does not entirely prevent deformity.What happens if a bicep tendon tear is left untreated? ›
Complete tears of the biceps tendon at the elbow do not heal back to the bone without surgery. There is loss of strength with elbow flexion and especially forearm rotation and often ongoing achy or cramping-type pain in the arm if the tendon is not repaired.
Your physical therapist and orthopedic surgeon will require you to wear a sling for four weeks following surgery and gradually build up your strengthening exercises as you get stronger.How long can you wait to repair a tendon? ›
Tendon repair isn't usually regarded as emergency surgery. But, it's generally carried out as quickly as possible after the injury – usually within a few days. This is because the longer the tendons remain ruptured, the more scarring will develop on the end of the tendons.How painful is bicep tendon surgery? ›
Swelling and pain is normal, especially for the first 48 hours. Each patient experiences discomfort to a different degree but you can expect your discomfort to decrease rapidly over the first 48-72 hours postoperatively. Ice can be applied as needed for 20 minutes at a time, with 20 minute breaks in-between.What is the test for a shoulder bicep tendon tear? ›
What is Yergason's test? Yergason's test is a physical test performed to help detect certain biceps tendon injuries — in particular, an injury to the long head of the biceps tendon. It can also assist in the diagnosis of a tear in your transverse humeral ligament, SLAP tear and biceps tendonitis.How do you tell if a tendon is torn or strained? ›
Severe and excruciating pain. Immediate bruising. Pain and discomfort that worsens with tendon use. A “crunchy” sound or feeling (crepitus) with tendon use.Can you lift after a bicep tear? ›
You may be able to do easier daily activities in 2 to 3 weeks, as long as you don't use your injured arm. Most people who work at a desk job can return to work in 1 to 2 weeks. If you lift, push, or pull at work, it may take 3 to 4 months or longer before you can go back to work.What are the 2 special tests we use to exam for biceps tendonitis? ›
Bicipital groove point tenderness is the most common isolated finding during physical examination of patients with biceps tendinitis. Ultrasonography is the best modality for evaluating isolated biceps tendinopathy extra-articularly. If other pathology is suspected, magnetic resonance imaging should be performed.Will an MRI show a torn bicep tendon? ›
Conclusions: Magnetic resonance imaging is an effective tool for diagnosing distal biceps tendon ruptures. Although MRI is extremely sensitive in diagnosing complete tears, it is substantially less sensitive in diagnosing partial tears.What does a minor bicep tear feel like? ›
The most obvious symptom will be a sudden, severe pain in the upper part of your arm or at the elbow, depending on where the tendon is injured. You may hear or feel a "pop" when a tendon tears. Other signs that you may have torn a biceps tendon can include: Sharp pain at the shoulder or elbow.How do doctors know if a tendon is torn? ›
The doctor can use imaging and other tests to confirm the extent of the injury. Some tendon ruptures can heal without surgery. However, complete tears will need surgery, particularly if the patient wishes to resume activities. Tendon repair surgery is also necessary if conservative treatment fails.
One of the most painful injuries of the feet and ankles is a ruptured Achilles tendon. The Achilles tendon is thick and long. On one end, it attaches to your heel bone; on the other end, the tendon is embedded in your calf muscle.How do you know if you need tendon surgery? ›
Hand tendon repair is needed when 1 or more tendons in your hand rupture (break or split) or are cut, leading to the loss of normal hand movements. If your extensor tendons are damaged, you'll be unable to straighten 1 or more fingers. If your flexor tendons are damaged, you'll be unable to bend 1 or more fingers.What kind of doctor do you see for a muscle injury? ›
If you have muscle pain as the result of an injury or condition, or even if you have no idea how it started, schedule an appointment with an orthopedic physician at the Center for Orthopaedic Surgery and Sports Medicine.How do you know if a muscle tear is serious? ›
Torn muscles are categorized by the severity of the injury: mild which is a simple strain affecting 5% of a muscle's fibers; moderate which is up to 25%-30% and accompanied by swelling, decreased range of motion and pain; and severe which is an actual tear in a muscle that is accompanied by extensive swelling.Where should I go for a muscle tear? ›
Generally, muscle strains are benign and can be treated at home. However, you should consider visiting an urgent care center if you experience any of the following symptoms after a muscle strain: Persistent pain or pain that radiates down the legs or arms.Can a doctor do anything for a torn ligament? ›
Doctors will use a combination of bracing, physical therapy, heat therapy, and medication to help with healing. The ligament responds well to these methods with a high overall success rate. The only caveat is the recovery time as ligaments and tendons lack blood vessels and have a low blood supply.How do you know if a torn ligament is serious? ›
While some ligament tears are relatively minor, you shouldn't take them lightly. Make sure to see your doctor right away if the pain and swelling don't decrease within 24 to 72 hours, you cannot bear any weight on the affected body part, or your symptoms get worse.What are the symptoms of a torn ligament in the arm? ›
- Pain and tenderness around the injury.
- Reduced range of motion around the arm, elbow, forearm or wrist.
- Stiffness around the elbow.
- Weakness in the hands and wrists.
You may benefit from surgery to repair the torn tendon if: Your symptoms cannot be relieved by nonsurgical treatments. You develop cramping in the muscle or pain. You require complete recovery of strength.Does a torn bicep require immediate surgery? ›
Most biceps tendon tears can be treated nonsurgically, but we can perform minimally invasive surgery called arthroscopy to repair it if necessary. We will help you get back to the activities you live for.
Nonsurgical treatment options include rest, ice and anti-inflammatory medications. Other nonsurgical treatments may include: Physical therapy and rehabilitation — exercises to help improve shoulder flexibility and build shoulder strength, your physical therapist will develop a treatment plan that is customized for you.What happens if torn bicep is left untreated? ›
Complete tears of the biceps tendon at the elbow do not heal back to the bone without surgery. There is loss of strength with elbow flexion and especially forearm rotation and often ongoing achy or cramping-type pain in the arm if the tendon is not repaired.How painful is a partial bicep tear? ›
No matter where your biceps tear is, sharp, sudden pain is a common symptom. Both partial and complete tears are painful and can significantly compromise your arm's mobility.Is bicep surgery outpatient? ›
What to expect from biceps tendon surgery. Surgical tendon repair usually takes place in an outpatient setting. You can go home the same day as the procedure.