Biceps Tendon Rupture

Biceps tendon tears can be either partial or complete.

Partial tears. These tears do not completely sever the tendon.

Complete tears. A complete tear will split the tendon into two pieces.

In most cases, tears of the distal biceps tendon are complete. This means that the entire muscle is detached from the bone and pulled toward the shoulder. Distal biceps tendon rupture is equally likely in the dominant and non-dominant arm.

Other arm muscles can substitute for the injured tendon, usually resulting in full motion and reasonable function. Left without surgical repair, however, the injured arm will have a 30% to 40% decrease in strength, mainly in twisting the forearm (supination).

Rupture of the biceps tendon at the elbow is unusual. It occurs in only one to two people per 100,000 each year, and rarely in women.

Cause

The main cause of a distal biceps tendon tear is a sudden injury. These tears are rarely associated with other medical conditions.

Injury

Injuries to the biceps tendon at the elbow usually occur when the elbow is forced straight against resistance. It is less common to injure this tendon when the elbow is forcibly bent against a heavy load.

Lifting a heavy box is a good example. Perhaps you grab it without realizing how much it weighs. You strain your biceps muscles and tendons trying to keep your arms bent, but the weight is too much and forces your arms straight. As you struggle, the stress on your biceps increases and the tendon tears away from the bone.

Risk Factors

  • Men, age 30 years or older, are most likely to tear the distal biceps tendon.

Additional risk factors for distal biceps tendon tear include:

  • Smoking. Nicotine use can affect nutrition in the tendon.
  • Corticosteroid medications. Using corticosteroids has been linked to increased muscle and tendon weakness

Symptoms

There is often a “pop” at the elbow when the tendon ruptures. Pain is severe at first, but may subside after a week or two.

Other symptoms include:

  • Swelling in the front of the elbow
  • Visible bruising in the elbow and forearm
  • Weakness in bending of the elbow
  • Weakness in twisting the forearm (supination)
  • A bulge in the upper part of the arm created by the recoiled, shortened biceps muscle
  • A gap in the front of the elbow created by the absence of the tendon

Diagnosis

Medical History and Physical Examination
After discussing your symptoms, your Wisconsin Bone & Joint orthopedic physician will review the events of the injury to determine how it occurred.

During the physical examination, your doctor will feel the front of your elbow, looking for a gap in the tendon. He or she will test the supination strength of your forearm by asking you to rotate your forearm against resistance. Your doctor will compare the supination strength to the strength of your opposite, uninjured forearm.

In addition to the examination, your doctor may recommend imaging tests to help confirm a diagnosis.IMG_5460_b_ copy

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 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

Nonsurgical treatment may be considered for patients who are elderly and inactive, or who have medical problems that make them high-risk for modest surgery.

Patients must weigh the decision to proceed with nonsurgical treatment carefully, because restoring arm function with later surgery may not be possible.

The tendon should be repaired during the first 2 to 3 weeks after injury. After this time, the tendon and biceps muscle begin to scar and shorten.

While other options are available for patients requesting late surgical treatment for this injury, they are more complicated and generally less successful.

Surgical Treatment

Procedure. Doctors use several procedures to reattach the distal biceps tendon to the forearm bone. Some doctors prefer to use two incisions, while others only one incision. There are pros and cons to each approach.

Sometimes the tendon is attached with stitches through holes drilled in the bone. Other times, small metal implants are used to attach the tendon to the bone.

Be sure to carefully discuss the options available with your doctor.

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