Biceps Tendon Tear

 Biceps tendon anatomy

Biceps tendon anatomy

The biceps is a muscle along the front of your upper arm that runs from your shoulder to the radius bone in your forearm.  It is important for flexing the elbow and “supinating” the forearm (turning the palm towards the ceiling).

The biceps tendon can tear or rupture from its distal insertion (into the radius) when lifting a heavy object.  While sometimes it may be due to underlying weakening of the tendon, or tendinitis, it often tears without any prior warning or symptoms.

 

Diagnosis

Patients oftentimes report a “pop” or “tearing” sensation in the front of their elbow associated with pain.  There is frequently bruising along the front and inside of the elbow and arm.  If the tendon retracts up the arm after tearing, there may be asymmetry between the two arms as one biceps muscle belly sits higher up the arm – the so-called “Popeye deformity”.  Biceps tendons are usually palpable, but this is no longer the case after a tear.  Other symptoms include pain and weakness when flexing the elbow or supinating (“rotating”) the forearm.  An MRI will show the injury, but is not always necessary to make the diagnosis.

Treatment

A completely torn biceps tendon cannot repair itself over time.  Elbow flexion strength may be acceptable after a tear because there are other muscles still present that bend the elbow.  However, when the end of the biceps tendon is no longer attached to bone, patients oftentimes have loss of endurance, fatigue during elbow flexion, and may experience cramping or discomfort when bending the elbow.  Weakness with rotation (supination) tends to persist.  While surgery is not absolutely required, it is oftentimes recommended.

If surgery it to be done, it should be done soon following the injury.  If too much time has passed, a direct repair of the tendon back to the bone may no longer be possible.

Schematic of biceps tendon repaired back to bone with suture and screw. Image from Arthrex.

  • After surgical repair, rehabilitation may vary slightly from case to case.  Typically, a patient is in a non-removable splint that holds the elbow bent at 90 degrees for the first 2 weeks after surgery. 

  • After ~2 weeks, elbow motion exercises are initiated. At this point, a removable elbow splint is used when sleeping and for activities.  While the elbow can be used between weeks 2 and 6, a common recommendation is to lift nothing heavier than a cup of coffee. 

  • At 6 weeks after the surgery, strengthening is usually initiated. The goal is full activities 3-4 months after surgery.


Dr. Schreiber is a board certified orthopedic surgeon specializing in hand, wrist, and elbow conditions. Dr. Schreiber practices at the Raleigh Orthopaedic Clinic in Raleigh, North Carolina.