Knee & Shoulder Surgeon - Orthopedic Specialist
Knee & Shoulder Surgeon - Dr. A. M. Rajani
M.S Orth (Gold Medallist), D-Orth, MBBS
Knee and Shoulder Surgeon
( Arthroscopy & Joint Reconstruction )
Orthopaedic Arthroscopy Knee & Shoulder Clinic (OAKS)


Biceps Tear

long head of biceps tendonThe long head of the biceps tendon is more likely to be injured. This is because it is vulnerable as it travels through the shoulder joint to its attachment point in the socket. Fortunately, the biceps has two attachments at the shoulder. The short head of the biceps rarely tears. Because of this second attachment, many people can still use their biceps even after a complete tear of the long head.

When you tear your biceps tendon, you can also damage other parts of your shoulder, such as the rotator cuff tendons.

» Type of Tears :
Partial tears : Many tears do not completely sever the tendon.
Complete tears : A complete tear will split the tendon into two pieces.

» Risk Factors :
Age: Older people have put more years of wear and tear on their tendons than younger people.
Heavy overhead activities: Too much load during weightlifting is a prime example of this risk, but many jobs require heavy overhead lifting and put excess wear and tear on the tendons.
Shoulder overuse: Repetitive overhead sports such as swimming or tennis can cause more tendon wear and tear.
Smoking: Nicotine use can affect nutrition in the tendon.
Corticosteroid medications: Using corticosteroids has been linked to increase muscle and tendon weakness.

» Causes of Biceps Tears
Injury
Fall hard on an outstretched arm or lifting something too heavy can tear your biceps tendon.
Overuse
Many tears are the result of a wearing down and fraying of the tendon that occurs slowly over time. This naturally occurs as we age. It can be worsen by overuse repetition of the same shoulder motions again and again.
proximal biceps tendon rupture
» Symptoms
  • Sudden, sharp pain in the upper arm
  • Audible pop or snap
  • Bruising from the middle of the upper arm down towards the elbow
  • Pain or tenderness at the shoulder and the elbow
  • Weakness in the shoulder and the elbow
  • As a torn tendon can no longer keeping the biceps muscle tight, a bulge in the upper arm above the elbow ("Popeye Muscle") may appear with a dent closer to the shoulder.
» Imaging Tests
X-Rays : Although X-rays cannot show soft tissues like the biceps tendon, they can be useful in ruling out other problems that can cause shoulder and elbow pain.
Magnetic Resonance Imaging (MRI) : These scans create better images of soft tissues. They can show both partial and complete tears.

» Treatment
Nonsurgical Treatment
Most people respond very well to conservative line of treatment. This would include:
Ice : Apply cold packs for 20 minutes at a time, several times a day to keep down swelling.
Nonsteroidal Anti-inflammatory medications : Drugs like ibuprofen, aspirin, or naproxen reduce pain and swelling.
Rest : Avoid heavy lifting and overhead activities to relieve pain and limit swelling. Your doctor may recommend using a sling for a brief time.
Physical therapy : Flexibility and strengthening exercises will restore movement and strengthen your shoulder.

» Indications for Surgery:
  • Atheletes
  • Young Patients
  • Failed Conservative Line
» Surgical Treatment:
Biceps Tenodesis :
Biceps tenodesis involves detaching the LHB from its superiorlabrum in the shoulder and reattach to the humerus bone just below the shoulder. This procedure is more complex than a tenotomy, but avoids the risks of biceps discomfort, weakness and a 'Popeye' appearance.



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