The biceps brachii is a muscle with two distinct muscle bellies. The short head of the biceps brachii originates from the coracoid process, and the long head of the biceps originates from the superior glenoid labrum. Both heads insert into the same place on the radial tuberosity. Because the biceps brachii crosses both the shoulder joint and elbow joint, it contributes to motion at both, however, primarily contributes to motion at the elbow. At the elbow biceps brachii both flexes and supinates the forearm. At the shoulder, the biceps brachii contributes to shoulder flexion.
The diagnosis of a biceps tear can refer to either a partial or complete tear of the proximal or distal tendon. A partial tear is any tearing of the biceps brachii tendon, in which it is not completely severed. A complete tear occurs when the biceps brachii tendon splits into two pieces. A distal tendon tear refers to a tear of the tendon at the distal insertion, and a proximal tendon tear refers to the tear of the long head of the biceps at the proximal insertion.
Factors associated with the increased risk of a biceps tendon tear include middle age, participation in heavy, overhead activities, overuse of the shoulder, smoking, and corticosteroid injections. Because the tendon is avascular, as it weakens, it can tear with a minimal amount of force. The most common mechanisms of injury include attempting to catch oneself when falling with an outstretched arm or an unexpected force when attempting to catch something, and most patients will report the feeling of a “snap” or “pop” at the time of injury.
A biceps tendon rupture can often be diagnosed through history and physical exam, although an X-ray may be ordered to rule out other diagnoses, and an MRI may be ordered to assess muscle and tendon damage. A tear of the proximal biceps tendon will result in a “Popeye” sign, in which a contraction of the biceps will cause the muscle belly to roll down over the distal humerus, with swelling closer to the elbow rather than the shoulder. A tear of the distal biceps tendon will result in a noticeable loss of strength in elbow flexion and supination, acute pain over the antecubital fossa, and possible ecchymosis over the antecubital fossa.
Proximal biceps tendon surgical repair is not often indicated in those over the age of 50. With physical therapy, functional limitations of activities involving supination and flexion are unusual because the short head of the biceps remains intact. In active individuals under the age of 50, surgical repair is often indicated. With surgical repair, the tendon will be anchored into the humerus deep to the pectoralis insertion.
Distal biceps tendon surgical repair is often indicated in those that are not low functioning or medically complicated. If surgical repair is not pursued 88% loss of elbow flexion strength and 74% loss of supination strength is expected.
After surgical repair, elbow motion will be protected for 6 weeks, after which ROM and gentle strengthening will begin. Based upon patient progression, after 6 months of healing, return to activity can be expected.
If you are having pain in your arm or have been diagnosed with a biceps tear, please come see us for a free consultation to see how we can assist you in your recovery. To request an appointment, click here, or call directly to one of our three locations during regular business hours:
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