Biceps tendon rupture
Tanja Unterberger studied journalism and communication science in Vienna. In 2015 she started her work as a medical editor at in Austria. In addition to writing specialist texts, magazine articles and news, the journalist also has experience in podcasting and video production.
More about the experts All content is checked by medical journalists.A biceps tendon rupture (also called biceps tendon tear) is a tear in one or more tendons of the biceps muscle. The cause is usually an overload of the tendon (for example through sport) or an injury (for example through an accident). Depending on which tendon is affected, non-surgical procedures such as immobilization and medication or surgery may be considered for treatment. You can find out more about causes, symptoms and treatment here!
ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. S46
Brief overview
- Treatment: Depending on the type and severity of the injury, the doctor treats a tear in the biceps tendon (biceps tendon rupture) conservatively (without surgery) or surgically.
- Symptoms: The first sign of a biceps tendon rupture is a loss of strength when bending the arm. Other symptoms include pain, swelling, bruising and deformation of the muscle (called "Popeye's arm").
- Description: Torn one or more biceps tendons
- Causes: The reason for a tendon rupture is usually stress that occurs, for example, during sports or as a result of accidents.
- Diagnosis: conversation with the doctor, physical examination (eye diagnosis, palpation examination, x-ray, ultrasound, MRI)
- Prognosis: Often a certain amount of strength in the arm remains, but those affected are usually not restricted in their everyday movement.
- Prevention: Warm up muscles and joints before exercising, avoid jerky movements and prolonged stress on the arms, refrain from smoking, allow injuries to the biceps tendons to heal.
How do you treat a biceps tendon rupture?
Most of the biceps tendon tears (about 90 percent) affect the long biceps tendon (LBS) inside the shoulder joint. The short (KBS) or distal (near the elbow) biceps tendon is rarely injured. Doctors treat a long or short biceps tendon tear with conservative procedures such as immobilization, medication, or physical therapy in most cases. In contrast, a distal biceps tendon tear usually requires an operation.
Treatment without surgery
The doctor decides together with the patient about the treatment for a torn biceps tendon. Which therapy is used depends on the respective complaints. Many of those affected feel little impaired in their everyday life, as the strength in the arm is usually only slightly restricted. In most cases, a tear in the long and short biceps tendon does not require surgery.
Instead, the doctor treats with conservative measures. First, it is necessary to immobilize the affected arm for a few days using a shoulder-arm bandage until the pain subsides. In most cases, the doctor also prescribes physiotherapy, in which the person concerned learns various movement exercises in order to strengthen the arm and maintain its mobility.
The doctor prescribes pain relievers, decongestants and anti-inflammatory drugs such as the active ingredients ibuprofen or diclofenac for the pain. This is taken as a tablet or capsule or as an ointment or gel applied to the painful area several times a day.
Placing ice on the affected area also helps to reduce swelling and pain. To do this, put ice in a plastic bag or wrap it in a towel. During the first 24 to 48 hours after the injury, apply the ice as often as possible for 15 to 20 minutes at a time.
In rare cases, the doctor will perform an operation if the long biceps tendon ruptures, as some sufferers find the often remaining muscle belly (muscle bulge on the forearm, also known colloquially as the "Popeye arm") cosmetically annoying.
surgery
The doctor usually treats a torn distal biceps tendon surgically. There are various surgical procedures for reattaching the torn tendon to the bone (reinsertion). This includes sewing, hanging or anchoring to the bone or looping around the bone.
In order to prevent a permanent loss of strength and function of the arm, an operation should be carried out promptly.
Surgery for rupture of the long (and short) biceps tendon
If the long (more rarely the short) tendon in the shoulder area is torn and especially if there are other injuries (e.g. torn rotator cuff), the doctor usually performs an arthroscopy.
To do this, he inserts an endoscope (consisting of a flexible rubber hose or a metal tube with a light source, lenses and a camera) into the joint cavity and first removes any remaining tendon remnants from the joint. He then attaches the torn tendon below the shoulder joint to the humerus (for example using a drill and anchoring systems made of titanium) or sutures it to the short biceps tendon.
Surgery for torn distal biceps tendon
If the distal (lower) biceps tendon, which is close to the elbow, tears, surgery is required in most cases. To do this, the surgeon attaches the tendon to the spoke (radius), which, together with the ulna, connects the upper arm with the forearm (e.g. by suturing or anchoring it to the bone).
If the biceps tendon is badly damaged and it is no longer possible to stitch it together, the doctor may replace it with a tendon from another muscle (tendon transplant).
Aftercare
After the operation, the arm is immobilized using a splint or a functional bandage. However, after a brief immobilization of the arm, patients are usually able to move the arm again.
For follow-up treatment, physiotherapy and movement exercises are used, which the person concerned carries out daily. These promote the healing process, keep the arm or shoulder joint flexible and strengthen the muscles.
The load is gradually increased. Heavier loads are usually possible again after about twelve weeks. The biceps tendon needs this time to grow in properly and to be fully resilient again.
In order to reduce possible pain and inflammation, the doctor usually prescribes additional pain relievers after the operation. Using ice packs after surgery also helps reduce swelling and pain.
Scheduled follow-up appointments after the operation are important in order to observe the progress of the healing.
Exercises
After the operation and arm immobilization, it is recommended that you stretch and strengthen your biceps and other arm muscles. The following exercises will help you to support the healing process:
Stretching biceps: To stretch your biceps, extend your arms together behind your back while standing. Keep your palms on top of each other. Now move your arms back and up until you feel a stretch. Hold the position for ten seconds and repeat the exercise about three times.
Strengthening the biceps: To strengthen the biceps muscles, raise your arms outstretched to the sides. Now lift your arms outstretched over your head and lower them back down to shoulder height. Repeat the exercise about 20 times. Later, to increase the load, do the exercise with weights in your hands.
Practice flexibility: To train the flexibility of your joints, alternately circle each arm ten times forwards and then ten times backwards. To work out the lower biceps tendon, extend your arms to your sides at shoulder level. Now alternately bend and straighten your forearm with the palms facing up. Repeat the exercise 20 times.
In order for an improvement to occur, it is important to do the exercises regularly (preferably daily).
How do you recognize a biceps tendon tear?
Symptoms of rupture of the long (and short) biceps tendon
Pain is not the focus of a long (and short) biceps tendon tear. In many cases, there is only a dull tenderness. What is noticeable, however, is the (usually only slight) loss of strength that occurs when the arm is bent. Shoulder pain, which often lasts for months without treatment, is also possible. In some cases, there is a bruise (hematoma) and swelling on the upper arm.
In addition, when the long tendon ruptures, the biceps muscle often shifts downward to form a noticeable ball. The resulting muscle belly on the forearm (also called Popeye syndrome or Popeye arm) is often not painful, but often cosmetically disturbing for those affected.
If the biceps tendon is only torn, pain can sometimes occur when the upper arm rotates and when the arms are stretched out over the head.
Symptoms when the distal biceps tendon ruptures
A rupture of the distal biceps tendon results in acute stabbing pain, which is often accompanied by a whip-crack-like sound. After that, there is usually pain with certain movements of the forearm such as screwing and lifting movements. These often do not subside even if the person concerned spares the arm.
Movement and flexion in the elbow are often severely restricted, and a bruise and swelling of the upper arm occurs. Often the outward rotation of the hand due to the rotation of the forearm (supination; when the arm is hanging, the palm faces forward) is hardly or not at all possible.
Also, if the distal biceps tendon ruptures, the biceps muscle will kick up rather than down like a long biceps tendon tear.
What is a biceps tendon rupture?
A biceps tendon rupture (also called biceps tendon tear) is a tear in one or more tendons of the biceps muscle (medical: Musculus biceps brachii, colloquially for short: "biceps"). Especially when doing sports (for example weightlifting), high loads usually affect the biceps muscles. In the event of overload, therefore, a tendon may tear. The long biceps tendon is particularly susceptible, less often the short or distal tendon (near the elbow).
Biceps anatomy
The biceps brachii muscle (Latin for "two-headed arm flexor muscle") belongs to the upper arm muscles. It is located in the front area of the upper arm between the shoulder joint and the spoke. Together with the brachialis muscle, it is responsible for flexing the forearm in the elbow joint.
On the shoulder, the biceps muscle is attached to the bone via two proximal tendons (facing the trunk) - the long biceps tendon (LBS) and the short biceps tendon (KBS). The muscle is anchored on the forearm or elbow via a tendon - the distal biceps tendon (running away from the trunk). Therefore, the muscle has two muscle heads in the upper area (caput longum = long head; caput breve = short head) - hence the name biceps (Latin for two-headed).
How does a biceps tendon tear occur?
Causes of a rupture of the long and short biceps tendon
A rupture of the long biceps tendon is usually caused by minor injuries to the tendon (minor trauma) that result from prolonged exposure to sport or physical work. The long biceps tendon tears when the tendon is previously damaged. Then even everyday movements may cause a crack.
Particularly during sport, the biceps muscles are subject to high mechanical loads. Often a tear in the long biceps tendon does not occur alone, but in connection with an injury to other soft tissues of the shoulder (for example the rotator cuff).
Causes of a distal biceps tendon tear
For a tear in the distal (lower) biceps tendon, jerky movements without great effort are often sufficient. It usually tears acutely after direct damage. This is the case, for example, when the person concerned lifts or catches a heavy object (such as lifting weights or playing handball).
Overloading or overstretching the biceps tendon in sports such as bouldering (climbing at jump height) also causes the biceps tendon to tear in some cases. Falls or a direct blow (for example in an accident) often also lead to a tear in the distal biceps tendon.
Who is particularly affected?
It often affects people who do a lot of sport (such as bodybuilders) or who work hard physically (such as construction workers). In addition, older people have a higher risk of tearing their biceps tendons due to age-related wear and tear.
Biceps tendon ruptures are also promoted by doping (taking anabolic steroids) or cortisone injections into the muscle. Smokers are also at an increased risk of torn biceps tendons.
How does the doctor make a diagnosis?
If you suspect a biceps tendon tear, your family doctor will usually refer you to an orthopedic specialist.
First, the doctor conducts a detailed discussion (anamnesis) about the symptoms and the possible cause of the injury. This gives the doctor the first clues as to whether a biceps tendon has ruptured.
This is followed by a physical examination. To do this, he examines the affected area and palpates it. Usually the orthopedic surgeon quickly recognizes from the typical deformation of the biceps muscle (for example the so-called "Popeye arm") that the tendon is torn (visual diagnosis).
In order to rule out a tear on the distal biceps tendon, the doctor carries out the so-called hook test. To do this, the patient presses his angled forearm against the doctor's hand. Then the doctor feels with his index finger in the angled arm whether the tightened elbow tendon can be felt.
To rule out a broken bone, the doctor also takes x-rays of the arm. For a reliable diagnosis and to rule out further injuries, further imaging procedures, such as an ultrasound examination (sonography) and magnetic resonance imaging (MRI), may be useful.
If you have persistent pain in the upper arm, elbow, or radiating pain in the shoulder, see a doctor as soon as possible after an injury.
What is the prognosis?
With or without surgery: After a biceps tendon rupture, there may be a reduction in strength when bending and rotating the forearm outwards. Early medical treatment is therefore very important. In most cases, however, those affected do not have to reckon with severe restrictions on movement in everyday life after successful treatment.
Even with the help of the most modern surgical procedures, it is not always possible for those affected to regain the full capacity of their arm during sport or at work. In most cases, however, the biceps tendons and muscles are again sufficiently resilient for the demands of everyday life.
Complications after the operation such as bleeding, infections, wound healing disorders, thromboses, and vascular or nerve injuries are also rare.
How can you prevent a biceps tendon rupture?
To prevent damage to the biceps tendons, it is advisable to keep a few things in mind:
- Warm up your muscles and joints with suitable exercises before exercise and before physical activity.
- Do not move your arms jerkily and do not exert prolonged tension on your arm muscles and joints.
- If you have pain in your arm, do not exercise or exercise until the symptoms have subsided.
- Allow inflammation and injuries to the biceps tendon to heal. Ask your doctor when you can start to put weight on your arm again and let the physiotherapist show you suitable exercises.
- Refrain from smoking.
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