A professional football player attempts an arm tackle and hears a pop in his upper arm. A weightlifter doing curls suddenly feels his shoulder "bubble." A woman rearranging the living room furniture gets a sharp pain in her shoulder. Each of these individuals just ruptured their biceps tendon.
Tendons attach muscle to bone. The biceps muscle in the upper arm splits near the shoulder into a long head and a short head. Both attach to the shoulder in different places. At the other end of the muscle, the distal bicep tendon connects to the smaller bone (radius) in the lower arm. These connections help the muscle stabilize the shoulder, rotate the lower arm and accelerate or decelerate the arm during overhead motions such as pitching.
The long head of the biceps tendon is vulnerable to injury because it travels through the shoulder joint to its attachment point. If it tears, you may lose some strength in your arms and be unable to turn your arm from palm down to palm up. Because the torn tendon can no longer keep the muscle taut, you may also notice a bulge in the upper arm (Popeye muscle). If the distal tendon tears, you may be unable to lift items or bend your elbow.
Ruptures of the distal tendon near the elbow are rare. They usually occur when an unexpected force is applied to a bent arm. For example, a snowboarder can rupture the distal biceps tendon if he uses the arm to try to break a fall during a turn.
The proximal biceps tendons near the shoulder tear more easily. Tears can be either partial or complete. Often, these tendons are already frayed, particularly if you are over 40 years old, have a history of shoulder pain, and participate in activities that involve overhead motions. Among the elderly, biceps tendon ruptures near the shoulder are often associated with rotator cuff tears.
Conservative treatment for biceps tendonitis can include:
Your physician will examine your arm and ask you to bend the arm and tighten the bicep muscle. The doctor may apply pressure to the top of the arm to see if there is any pain. If you have a history of shoulder pain, your doctor may request an magnetic resonance imaging (MRI) scan or a special x-ray called an arthrogram to see if you have also torn the rotator cuff muscle.
Conservative treatment is usually all that is needed for tears in the proximal biceps tendons. Ice applications keep down the swelling, and nonsteroidal anti-inflammatory medications (NSAIDS) such as ibuprofen reduce pain.
You should rest the muscle, limiting your activity when you feel pain or weakness. To keep the shoulder mobile and strengthen the surrounding muscles, your doctor may prescribe some flexibility and strengthening exercises.
Complete tears of the distal biceps tendon require surgery to reattach the tendon to the bone. Range of motion exercises can begin as early as two weeks after surgery, although forceful biceps activity is often restricted for four to six months. Partial tears of the distal biceps tendon may be treated either conservatively or surgically. You and your orthopaedic surgeon should discuss the options for your specific case.
Surgical repair of a complete tendon tear can be done for younger individuals whose work involves heavy labor or lifting.
The best way to prevent reoccurrences of a biceps rupture is to only return to practice and competition when all symptoms of the injury are gone and strength of the affected arm has returned to normal. Furthermore, the rehabilitation exercises should be continued to ensure protective strength, range of motion, and stability of the injured joint. Other prevention techniques include:
The key to improving sports performance after recovering from a biceps rupture is a proper a rehabilitation program, and adhering to some of those same principles after the injury is gone.
The single most important aspect of improving performance is stretching before and after you step onto the field, court, ice, or golf course.
Benefits derived from stretching include:
As an athlete, your number one concern is getting back to full strength as soon as possible so that you can return to training and competition. That is why appropriate rehabilitation is extremely important. The most common rehabilitation for a biceps rupture often includes the following:
The major objectives of rehabilitation from a biceps rupture are to improve the elasticity of the biceps muscle and to gradually increase pain-free range of motion. The exercises below stretch the muscles of the forearm and upper arm. These exercises should be performed once or twice daily. Exercises include:
During the period when normal training should be avoided, alternative exercises may be used. These activities should not require any actions that create or intensify pain at the site of injury. They include:
Your biceps rupture may require surgery to reattach the tendon to the bone. Keep in mind that the soft tissue needs time to heal before exercise can begin. A physical therapy program usually begins with range-of-motion and resistive exercises, then incorporates power, aerobic and muscular endurance, flexibility, and coordination drills.
Finally, patients develop speed and agility through sport-specific exercise routines.
The ultimate goal of surgery is to provide dynamic stability while maintaining full range of motion, so that athletes can return to competitive or recreational sports. Progress is assessed by the patient's perception of how stable the biceps muscle feels and by comparing the strength and stability of the injured and uninjured arms.
The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your biceps rupture recovers, not by how many days or weeks it has been since your injury occurred.
It also depends on how serious the injury is. Instances where you have a complete tear of the distal biceps tendon, and reconstructive surgery is required, may require up to 6 months before you can return to full participation. For patients with a partial tear, you may be back to normal activity in 2 to 3 months.
A good rule is to allow pain to dictate when you're ready to return to activity. You should return in moderation, and back off if you feel any pain.
You may safely return to your sport or activity when you have full strength and range of motion in the injured arm compared to the uninjured arm.
Gentle rehabilitation exercises may be performed within a few weeks, but keep in mind that forceful biceps activity is often restricted for 4 to 6 months. Of course, time for return to activity is much longer when surgery is necessary.