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 to the shoulder and elbow. The biceps can tear at the shoulder or the elbow.
The biceps bends the elbow and turns the arm so that the palm faces up (supination).
It has two tendon attachments (long head and short head) at the shoulder on one end and one tendon where it attaches to the elbow at the other end.
It most commonly occurs in males 40-60 years of age.
Causes
Usually there is some pre-existing fraying of the tendons which eventually progresses and causes a complete tear during a strenuous activity. These include:
- Heavy Lifting.
- Fall.
- Sports.
There are a number of risk factors:
- Age.
- Smoking.
- Overuse of shoulder.
- Male Sex.
Signs and Symptoms
Diagnosis is based on symptoms, examination findings and scans
- Sudden Pain / Pop in the shoulder.
- Cramping of muscle.
- Weakness in turning the hand to face palm up.
- Shoulder and Elbow Weakness.
- Bruising.
- Rotator Cuff Tear – there may be co-existing injury to the rotator cuff tendons in the shoulder at the same time.
Tests
Ultrasound
This will diagnose the tear in most cases.
MRI Scan
This is the most sensitive test in diagnosing the exact location of the tear and visualising the end of the ruptured tendon. It will also reveal if there is damage to the other shoulder tendons (rotator cuff).
Non-surgical treatment
Not all patients require surgery.
There may be 10-20% loss of supination strength (weakness in turning the palm up). For many people this is not noticeable enough to cause problems with everyday use. Occasional muscle cramping may also occur.
Without surgery, muscle will have a persistent ‘popeye’ appearance which is not a concern for most people.
The pain, bruising and swelling settles over a few weeks.
Pain Killers / Anti Inflammatory Medications
These assist with pain only.
Ice
Ice will help with pain and swelling in first 2-3 days.
Physiotherapy
Physiotherapy can be used to help with swelling, cramping and movement.
Recovery and Return to Sport
Patients can use the arm as soon as they feel comfortable if treated non surgically.