Your biceps muscle runs along the front of your upper arm, from your shoulder to your elbow. The upper part of this muscle is attached to your shoulder by two tendons (the proximal biceps tendons): the long head of the biceps connects the muscle to the top of the shoulder socket (the glenoid) while the short head of the biceps connects to a bony knob on the scapula.
The long head of biceps tendon is the most likely to be injured because it is more vulnerable as it travels through the shoulder joint. The short head of biceps tendon rarely tears which means that you are able to continue using your biceps even if you completely rupture the long head of biceps tendon.
What are proximal biceps tears?
Your proximal biceps tendon may start to fray through overuse or as a result of the ageing process. The tendon may tear partially or completely (where the tendons is torn away from the bone – also called a rupture). A tear may be caused by a sudden trauma, such as lifting something that is too heavy or falling heavily onto an outstretched arm or by making repetitive shoulder movements. Falling awkwardly or twisting your elbow can also cause biceps tendon tears. In young adults proximal biceps tears can occur but are relatively rare. In patients aged fifty or over the tear is usually associated with a wearing of the nearby rotator cuff tendons, which has most often occurred without an injury and may not have caused any symptoms.
What is at risk?
If you have shoulder impingement, a rotator cuff injury or tendinitis, your biceps tendon is subjected to more stress putting you more at risk of it weakening and tearing. The older you are the greater the likelihood of a proximal biceps tear due to wear and tear on the tendons. Jobs that require a lot of heavy overhead lifting or lifting weights that are too heavy also increase your risk, as does smoking and taking corticosteroids which can weaken the tendons and soft tissues. Certain sports that require repetitive overhead movements – such as tennis and swimming – increase wear and tear on the tendons and so make tears more likely.
Symptoms of proximal biceps tears
If you tear your proximal biceps you may experience:
- Pain in your shoulder and upper arm
- An audible pop or snap, accompanied by a sudden sharp pain in your upper arm.
- Bruising from the middle of the upper arm towards the elbow.
- A bulge in the upper arm above the elbow and a dent near the shoulder when you contract the muscle (“Popeye Muscle”)
The symptoms may vary in severity depending on whether you have a partial or complete tear.
Diagnosing proximal biceps tears
If you have a suspected tendon tear you may be given an ultrasound which will reveal if it is a partial or complete tear. This will also assess the rest of the rotator cuff. MRI scans can also be useful but can be more difficult to interpret with respect to the biceps tendon. An X-ray may be used to rule out other possible causes of shoulder pain.
Treatment of proximal biceps tears
Once torn, the tendon will not naturally heal back to where it used to be and the muscle bunching near the elbow with always be present. In the vast majority of cases the pain and bruising will eventually subside and the strength of the arm of will return to normal as the other proximal biceps tendon strengthens to compensate. Rest and ice will often help to heal a long head of biceps tear, with anti-inflammatories to relieve pain and swelling and physiotherapy to restore shoulder strength and flexibility.
Surgery may be recommended for a number of reasons. Many people are not comfortable with muscle bulging and bunching near the elbow and wish to have surgery with the aim of correcting this. Others having ongoing cramping symptoms from the retraction of the muscle, even after several months of rehab. The procedure to reattach a ruptured proximal biceps tendon is called a biceps tenodesis. There are different approaches and all involve fixing the tendon lower down on the humerus bone. The tendon may be attached onto the surface of the bone or into the bone itself. Your surgeon will discuss the best approach with you.
Thames Shoulder and Elbow can offer advice on the diagnosis and treatment of proximal tendon tears as well as surgical repair.
Orthopaedic Consultant & Surgeon | London
Thames Shoulder & Elbow are able to provide advice and support to anyone experiencing symptoms affecting the upper limbs (shoulder, upper arm, elbow, forearm and wrist).
Telephone: 020 376 15987
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