Bicep Tendon Tear
What is a Bicep Tendon Tear?
The biceps muscle, located in the front of the upper arm allows you to bend the elbow and rotate the arm. Biceps tendons attach the biceps muscle to the bones in the shoulder and in the elbow.
Biceps tear can be complete or partial. Partial biceps tendon tears will not completely break the tendon. Complete tendon tears will break the tendon into two parts.
Biceps tendon tears at the elbow: Although two tendons attach the biceps muscle to the bone at the shoulder, only one tendon attaches it to the elbow. This is known as the distal biceps tendon. Tears of the distal biceps tendon are usually complete and the muscle is separated from the bone. Tears of the distal biceps tendon most often result from a sudden injury or lifting a heavy object.
Causes of Bicep Tendon Tears
Biceps tendon tear can be caused by injury such as falling with your arm outstretched or during the act of lifting heavy objects. In case of overuse, a tendon may fray and eventually tear. Additional risk factors such as advancing age, heavy overhead activities, repetitive overhead sports, smoking, and use of corticosteroids can also result in a tendon tear.
Symptoms of Bicep Tendon Tears
The most common symptom is a sudden, severe pain in the upper arm or at the elbow, depending on where the tendon is injured. At times, you may hear a “pop”. Other symptoms include swelling, visible bruising, weakness in the shoulder or elbow, and trouble turning your palm up or palm down. A bulge referred to as a “Popeye Muscle,” may also appear in your arm, because the tendon is no longer holding the muscle in place properly.
Diagnosis of Bicep Tendon Tears
Biceps tendon tear is usually diagnosed based on your symptoms, medical history, and a physical examination. During the physical examination, your doctor will look for a gap in the front of the elbow. Your doctor will diagnose a partial tear by asking you to bend your arm and tighten the biceps muscle. You may have pain if there is a partial tear. X-rays may be taken to rule out other conditions causing shoulder and elbow pain. Using an MRI scan, your doctor can know whether the tear is partial or complete.
Treatment Options for Bicep Tendon Tears
Biceps tendon rupture is a complete tearing away of the tendon from the bone. Distal biceps tendon ruptures at the elbow are almost always treated surgically, where the distal biceps is reattached to the bone, using heavy sutures and tunnels in the bone.
Postoperative Rehabilitation Distal Biceps Repair
Beginning at 1-2 weeks post-operative, a ROM brace is placed, with an extension block at 30°. Active and PROM exercises are initiated to the elbow, forearm, wrist and digits 6 times a day for 10 minute sessions. The brace should be worn during these sessions
3 Week Postop
Active and PROM exercises are initiated to the elbow, forearm, wrist and digits 6 times a day for 10 minute sessions, with the elbow out of the brace. The brace can be unlocked during these exercises. Elbow extension is restricted to 20° when in the brace.
4 Weeks Postop
Active and PROM exercises are initiated to the elbow, forearm, wrist and digits 6 times a day for 10 minute sessions, with the elbow out of the brace. The brace can be unlocked during these exercises. Elbow extension is restricted to 0° when in the brace.
6 Week Postop
Active and PROM exercises are initiated to the elbow, forearm, wrist and digits 6 times a day for 10 minute sessions, with the elbow out of the brace. The brace may be discontinued at this time.
Dynamic splinting may be initiated for the elbow and/or forearm if PROM remains limited. Progressive strengthening may be initiated for the elbow, forearm, wrist and hand.
10-12 Weeks Postop
Progressive strengthening may be initiated for the elbow, forearm, wrist and hand. A work conditioning program is recommended for patients with manual labor jobs that require heavy lifting.
Patients are cautioned against unrestricted use of the arm until 6 months postop.
A loss of active elbow flexion between weeks 1 and 6 can be a sign that the repair is being stretched out or becoming loose. Any loss of active flexion that cannot be easily recaptured or attributed to the elbow stiffness should be brought to the immediate attention of the surgeon. When a loss of motion is noted, active extension is limited to 60°, exercise sessions are reduced to 3 – 4 times a day, and the ROM brace is adjusted to 60° until the active flexion is recaptured. Typically, this occurs within 7 – 10 days