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Elbow

Biceps Tendon Repair

Muscles are attached to bone by tendons. The biceps muscle at the front of the upper arm is attached by two tendons to the shoulder and one tendon to the elbow. The long head of the biceps tendon attaches to the top of the shoulder called the glenoid. The short head of the biceps tendon attaches to a bump on the shoulder blade.

The biceps tendons can tear at the shoulder or the elbow from overuse or injury. A biceps tendon tear at the shoulder can damage the shoulder rotator cuff tendons.

What causes a biceps tendon tear?

  • Biceps tendons can be torn by injury such a fall on an outstretched arm, or twisting the elbow or shoulder.
  • A biceps tendon tears at the elbow is are frequently caused by heavy lifting at a job or from weight lifting.
  • Shoulder overuse due to overhead sports like swimming, tennis, and throwing sports can cause a tear. The tear may be preceded by tendonitis which causes microtraumas that lead to fraying.
  • Aging is a common cause of a biceps tendon tear. With age, normal wear and tear frays the tendon over time and eventually leads to a tear.
  • Smoking and corticosteroids can increase the risk of a tendon tear.

Types of biceps tears

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.

A proximal biceps tears is when the tendon tears at the shoulder.  It can occur in the long head that attaches the muscle to the top of the shoulder socket or the short head that attaches to the front of the shoulder. When the long head is torn it is called a proximal biceps tear. The short head remains functional and rarely tears which may allow someone with a proximal biceps tear to continue to use their biceps. A distal biceps tear occurs when the tendon tears at the elbow.

What are the symptoms of a biceps tear?

Some or all symptoms may be present depending on the type and severity of the tear.

  • Sudden severe pain either at the elbow or shoulder
  • Bruising near the tear
  • Biceps muscle cramping with use
  • Tenderness at the site of the tear
  • Reduced range of motion
  • Weakness in the shoulder or elbow
  • Difficulty rotating the forearm at the elbow to turn the palm up or down
  • A bulge in the front of the upper arm or a bulge above the elbow where the tendon bunches up is an indication of a complete tear.

How is a biceps tendon tear diagnosed?

Dr. Hackett will review your medical history, ask about your symptoms and how the injury occurred. He will conduct physical exam including strength testing, 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.

What are the treatment options for a biceps tendon tear?

A complete tear of the bicep tendon cannot heal itself; and requires surgery to reattach the tendon to bone. Partial tears usually do not require surgery. The decision to pursue surgery depends on the patient’s desire to return to sports and activities that make life enjoyable.

For shoulder tears of the long head, non-surgical management may be sufficient to resolve pain and improve function. Surgery for the long head tear is usually unnecessary, except for those who rely on the strength needed to participate in sports or heavy labor. Additionally, surgery might be recommended when the patient continues to have symptoms after a trial of non-surgical management for a partial tear.  Surgery can restore function and with therapy restore strength. The risk of retearing is low.

A distal biceps tear at the elbow is uncommon and frequently results from an injury or heavy lifting and requires surgery to restore function. A distal biceps tear is usually a complete tear of the tendon off the bone. Weakness in performing palm up movements indicates a distal tear. Because of this disability many patients choose surgery, despite being able to function reasonably well except when needing the palm up rotation for work or sports.

A distal biceps tear is unique in that surgery must be performed within a week or two of the diagnosis to prevent scarring which can complicate repair surgery, and even cause permanent muscle degeneration (atrophy). Surgery reattaches the torn tendon to the bone. Complete healing can require three months of physical therapy but provides restoration of full range of motion and virtually normal strength.

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. The surgery reattaches the tendon back to the bone. Complications are rare. Rehabilitation is essential to restore range of motion and strength.

Dr. Tom Hackett is a skilled and experienced sports medicine expert focused on the shoulder, elbow and knee and an expert in arthroscopic surgery. Contact him to schedule a consultation and learn about all your treatment options.


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