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Proximal Biceps Tendon Rupture (At The Shoulder)

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Proximal Biceps Tendon Rupture (At The Shoulder)

 

Anatomy

The biceps tendon has 2 parts to it, the long head of the biceps and the short head of the biceps tendon.  The long head of the biceps tendon starts at the superior labrum, which is the cartilage soft tissue that wraps around the glenoid or socket and inserts in the elbow at the radial tuberosity.  The short head of the biceps tendon also starts in the shoulder and ends in the elbow but starts at the coracoid, which is the part of the shoulder blade or scapula, and attaches in the elbow as well.

Causes

Biceps tendon injuries occur from either overuse or due to a traumatic event or injury.  Overuse can occur from injury to the biceps tendon that occurs over time.  This can lead to fraying of the biceps tendon followed by partial tearing and finally complete tearing of the long head of the biceps tendon.  Once a complete tear of the the biceps tendon occurs, the biceps will role down the arm.  Furthermore, this overuse can cause injury to the soft tissues around the biceps tendon such as the rotator cuff tendon.  Repetitive trauma to the rotator cuff can lead to a tear.  Traumatic injury such as a fall or lifting something heavy can lead to an immediate injury to the biceps tendon with a partial tear even a complete biceps tendon tear.  People who are at risk for biceps tendon injury in the shoulder are people who are overhead laborers such as electricians, construction workers, or painters.  People who are older are also at risk for a biceps tendon tear due to years of use and small microtrauma to the biceps tendon that can lead to a tear over time.

Symptoms

The patients that have a proximal biceps tendon rupture or a tear at the shoulder will complain of feeling sharp pain in the arm possibly associated with a pop.  Some patients complain of a cramping sensation in the biceps area associated with bruising in the arm and swelling.  Some patient will also complain of weakness in the shoulder and arm area especially with rotating the arm from palm down to palm up with resistance.  Patients with a complete rupture may notice a mass in the arm that occurs immediately after a rupture of the biceps tenon which is called a “Popeye sign.”

Physical Examination

Your physician will assess the arm for range of motion and strengthening.  Physician will also do specific tests of the biceps tendon to check for weakness with resistance in rotating the arm from the palm down to palm up position.  Also your doctor will assess for signs of swelling in the arm due to the rupture of the biceps called a “Popeye sign.”

Imaging Studies

X-rays:  X-rays will be performed to assess for any fracture or abnormality to the bone.  Soft tissue injuries such as a biceps tendon rupture will not be visualized on x-rays unless a fragment of bone had been avulsed off at the time of injury.
MRI: 
An MRI will be performed to assess for a biceps tendon rupture proximally in the shoulder.  MRIs are used to assess for any soft tissue injury and are the best study for assessing soft tissue injuries.

Nonsurgical Treatment

Many patients that have a proximal biceps tendon rupture of the shoulder will not require surgical intervention for reattachment of the biceps tendon.  Patients who are older and not as active will most likely be treated with nonsurgical intervention such as icing, nonsteroidal antiinflammatory drugs (NSAIDs).  Physical therapy may be added once the pain has resolved to regain range of motion and strength back to the shoulder and arm.

Surgical Treatment

Surgical treatment for a proximal biceps tendon rupture in the shoulder is rarely performed.  This reattachment of the proximal biceps tendon rupture is normally only performed in patients who are heavy laborers or athletes that need the biceps tendon for their work or activity.

Procedure

The patients who do undergo surgical intervention for a proximal biceps tendon rupture will normally have either an arthroscopic or open biceps tenodesis procedure performed.  In this procedure, the biceps tendon that has been avulsed or torn is reattached to the humerus or arm bone with an anchor and/or stitches of some sort.

Rehabilitation

After a biceps tenodesis procedure for the ruptured biceps tendon, the patient is immobilized initially for approximately 3 weeks.  After immobilization, physical therapy is started to regain range of motion and strength back to the arm.  Most patients are able to return back to all activities within 3-4 months after surgery.

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