Biceps Tendon Tear at the Shoulder
Biceps Tendon Tear at the Shoulder
Tendons
attach muscles to bones. Your biceps tendons attach the biceps muscle to bones
in the shoulder and in the elbow. If you tear the biceps tendon at the
shoulder, you may lose some strength in your arm and have pain when you
forcefully turn your arm from palm down to palm up.
Many
people can still function with a biceps tendon tear, and only need simple
treatments to relieve symptoms. If symptoms cannot be relieved by nonsurgical
treatments, or if a patient requires complete recovery of strength, surgery to
repair the torn tendon may be required.
There are two attachments of the
biceps tendon at the shoulder joint.
Your
shoulder is a ball-and-socket joint made up of three bones: your upper arm bone
(humerus), your shoulder blade (scapula), and your collarbone (clavicle).
The head
of your upper arm bone fits into a rounded socket in your shoulder blade. This
socket is called the glenoid. A combination of muscles and tendons keeps your
arm bone centered in your shoulder socket. These tissues are called the rotator
cuff. They cover the head of your upper arm bone and attach it to your shoulder
blade.
The upper
end of the biceps muscle has two tendons that attach it to bones in the
shoulder. The long head attaches to the top of the shoulder socket (glenoid).
The short head attaches to a bump on the shoulder blade called the coracoid
process.
Biceps
tendon tears can be either partial or complete.
A complete tear of the long head at
its attachment point in the glenoid.
- Partial tears. Many tears do not completely sever the tendon.
- Complete tears. A complete tear will split the tendon into two
pieces.
In many
cases, torn tendons begin by fraying. As the damage progresses, the tendon can
completely tear, sometimes when lifting a heavy object.
The 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.
There are
two main causes of biceps tendon tears: injury and overuse.
Ø
Injury
If you fall hard on an outstretched
arm or lift something too heavy, you can tear your biceps tendon.
Ø
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 worsened by overuse - repeating the same
shoulder motions again and again.
Overuse
can cause a range of shoulder problems, including tendinitis, shoulder
impingement, and rotator cuff injuries. Having any of these conditions puts
more stress on the biceps tendon, making it more likely to weaken or tear.
Ø
Risk
Factors
Your risk for a tendon tear
increases with:
·
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 increased muscle and tendon weakness.
- Sudden, sharp pain in the upper
arm
- Sometimes an audible pop or
snap
- Cramping of the biceps muscle
with strenuous use of the arm
- Bruising from the middle of the
upper arm down toward the elbow
- Pain or tenderness at the shoulder
and the elbow
- Weakness in the shoulder and
the elbow
- Difficulty turning the arm palm
up or palm down
- Because a torn tendon can no
longer keep the biceps muscle tight, a bulge in the upper arm above the
elbow ("Popeye Muscle") may appear, with a dent closer to the
shoulder.
Doctor Examination
Medical History and Physical Examination
After discussing your symptoms and
medical history, your doctor will examine your shoulder. The diagnosis is often
obvious for complete ruptures because of the deformity of the arm muscle
("Popeye Muscle").
A biceps tendon tear is made more
obvious by contracting the muscle ("Popeye Muscle").
Partial
ruptures are less obvious. To diagnose a partial tear, doctor may ask you to
bend your arm and tighten the biceps muscle. Pain when you use your biceps
muscle may mean there is a partial tear.
It is also
very important that doctor identify any other shoulder problems when planning
your treatment. The biceps can also tear near the elbow, although this is less
common. A tear near the elbow will cause a "gap" in the front of the
elbow. Doctor will check your arm for damage to this area.
In
addition, rotator cuff injuries, impingement, and tendinitis are some
conditions that may accompany a biceps tendon tear. Your doctor may order
additional tests to help identify other problems in your 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
Ø
Nonsurgical
Treatment
For many people, pain from a long
head of biceps tendon tear resolves over time. Mild arm weakness or arm
deformity may not bother some patients, such as older and less active people.
In
addition, if you have not damaged a more critical structure, such as the
rotator cuff, nonsurgical treatment is a reasonable option. This can include:
Ø Ice. Apply
cold packs for 20 minutes at a time, several times a day to keep down swelling.
Do not apply ice directly to the skin.
Ø Nonsteroidal anti-inflammatory medications. Drugs like ibuprofen, or naproxen reduce pain and
swelling.
Ø Rest. Avoid
heavy lifting and overhead activities to relieve pain and limit swelling. Doctor
may recommend using a sling for a brief time.
Ø Physical therapy. Flexibility
and strengthening exercises will restore movement and strengthen your shoulder.
Ø
Surgical
Treatment
Surgical treatment for a long head
of the biceps tendon tear is rarely needed. However, some patients who develop
cramping of the muscle or pain, or who require complete recovery of strength,
such as athletes or manual laborers, may require surgery. Surgery may also be
the right option for those with partial tears whose symptoms are not relieved
with nonsurgical treatment.
Procedure. Several new procedures have been developed that repair
the tendon with minimal incisions. The goal of the surgery is to re-anchor the
torn tendon back to the bone. Your doctor will discuss with you the options
that are best for your specific case.
Complications. Complications with this surgery are rare. Re-rupture
of the repaired tendon is uncommon.
Rehabilitation. After surgery, your shoulder
may be immobilized temporarily with a sling.
Your
doctor will soon start you on therapeutic exercises. Flexibility exercises will
improve range of motion in your shoulder. Exercises to strengthen your shoulder
will gradually be added to your rehabilitation plan.
Be sure to
follow your doctor's treatment plan. Although it is a slow process, your
commitment to physical therapy is the most important factor in returning to all
the activities you enjoy.
Surgical
Outcome. Successful surgery can correct
muscle deformity and return your arm's strength and function to nearly normal.
--The End--
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