Introduction
The biceps is a large muscle which sits at the front of the arm. The tendons on either side of the muscle attach it bones on the shoulder and elbow. The biceps tendon can tear at the shoulder or elbow insertions.
It has two tendon attachments (long head and short head) at the shoulder on one end and one tendon where it attaches to the top of the radius bone at the elbow.
The biceps bends the elbow and turns the arm so that the palm faces up (supination).
Biceps tendon tears at the elbow most commonly occurs in males 30-60 years of age. It is rare and it occurs in 3 to 5 out of 100,000 people.
The tendon tears suddenly when a force is applied to a bent elbow, e.g. when lifting a heavy object.
Causes
- Heavy Lifting.
- Work injury causing forceful movement.
- Sports.
- There may be some pre-existing tendon fraying / degeneration which predisposes to the tear.
Signs and Symptoms
Diagnosis is based on symptoms, examination findings and scans:
- Sudden Pain / Pop in elbow.
- Cramping / fatigue of muscle.
- Weakness in bending the elbow and turning the hand to face palm up.
- ‘Popeye sign’. As the tendon is ruptured, the muscle curls / rolls up.
- Bruising in the elbow and forearm.
Tests
Ultrasound
This will diagnose the tear in most cases.
MRI
This is the most sensitive test in diagnosing the exact location of the tear and visualising the end of the ruptured tendon.
Non-surgical treatment
The tendon DOES NOT heal back onto the bone by itself. Non-surgical treatment is an option in those who have relatively sedentary lifestyles and who are not concerned about the weakness in the arm or cosmetic appearance.
If left unrepaired, there is about 30% loss of strength in bending the elbow and supination (weakness in turning the palm up) and the arm may cramp and fatigue more easily with repetitive use.
Without surgery, the muscle will show a persistent ‘popeye’ appearance.
The pain, bruising and swelling settles over a few weeks.
Pain Killers / Anti-inflammatory Medications
These assist with pain only.
Ice
This will help with pain and swelling in first 2-3 days.
Physiotherapy
Physiotherapy may be required to help with swelling and movement.
Recovery and Return to Sport
Patients can use the arm as soon as they feel comfortable if treate non surgically.