What is a biceps tendon rupture?

A biceps tendon rupture is an injury that occurs to the biceps tendon causing the attachment to separate from the bone. A normal biceps tendon is connected strongly to the bone. When the biceps tendon ruptures, this tendon is detached. Following a biceps tendon rupture, the muscle cannot pull on the bone, and certain movements may be weakened and painful.

Biceps tendon tear

Biceps tendon tear

There are two types of biceps tendon ruptures:

  • Proximal Biceps Tendon Ruptures
    A proximal biceps tendon rupture is an injury to the biceps tendon at the shoulder joint. This injury type is the most common type of biceps tendon injury. It is most common in patients over 60 years of age, and often causes minimal symptoms.
  • Distal Biceps Tendon Ruptures
    The distal biceps tendon is injured around the elbow joint. This is usually an injury that occurs with heavy lifting or sports in middle-aged men. Most patients with a distal biceps rupture will have surgery to repair the torn tendon.
  • Rupture of the proximal head of the biceps tendon involves one of two heads of the biceps tendon. This condition usually occurs in older individuals and is caused by degenerative changes within the biceps tendon leading to failure of the structure. Most patients have preceding shoulder pain consistent with impingement syndrome or a rotator cuff tear. The proximal biceps tendon rupture may then occur during a trivial activity, and some patients may experience some pain relief once the damaged tendon ruptures.The proximal biceps tendon can rupture in a younger patient with activities such as weight-lifting or throwing sports, but this is quite unusual.

What are the causes of Biceps Tendon Rupture?

Biceps ruptures generally occur in people who are between 40 and 60 years old. People in this age group who’ve had shoulder problems for a long time are at most risk. Often the biceps ruptures after a long history of shoulder pain from tendonitis (inflammation of the tendon) or problems with shoulder impingement. Shoulder impingement is a condition where the soft tissues between the ball of the upper arm and the top of the shoulder blade (acromion) get squeezed with arm motion.

Years of shoulder wear and tear begin to fray the biceps tendon. Eventually, the long head of the biceps weakens and becomes prone to tears or ruptures. Examination of the tissues within most torn or ruptured biceps tendons commonly shows signs of degeneration. Degeneration in a tendon causes a loss of the normal arrangement of the collagen fibers that join together to form the tendon. Some of the individual strands of the tendon become jumbled due to the degeneration, other fibers break, and the tendon loses strength.

A rupture of the biceps tendon can happen from a seemingly minor injury. When it happens for no apparent reason, the rupture is callednontraumatic.

Aging adults with rotator cuff tears also commonly have a biceps tendon rupture. When the rotator cuff is torn, the ball of the humerus is free to move too far up and forward in the shoulder socket and can impact the biceps tendon. The damage may begin to weaken the biceps tendon and cause it to eventually rupture.

What are the symptoms of a proximal biceps tendon rupture?

Usually patients will have sudden pain associated with an audible snap in the area of their shoulder. The pain is usually not significant, and, as mentioned previously, some patients may experience pain relief after the rupture. After the ruptured tendon retracts, patients may notice a bulge in their arm at the biceps muscle. This is the retracted muscle bunched up in the arm, and is sometime referred to as a “Popeye Muscle,” because the muscle is more pronounced than normal.

What is the treatment for a proximal biceps tendon rupture?

Patients usually do not notice any loss of arm or shoulder function following a proximal biceps tendon rupture. A slight bulge in the arm, and some twitching of the retracted muscle are usually the most significant symptoms. Surgical repair of the proximal biceps tendon is usually only considered in the case of a younger patient who is more active.

The reason there is little functional loss following a proximal biceps tendon rupture is that there are actually two tendinous attachments of the biceps at the shoulder joint (that is why the muscle is named “bi-ceps,” meaning two heads). When the rupture occurs at the distal biceps tendon at the elbow, where there is only one attachment, surgical repair is much more commonly needed.

If pain persists following a proximal biceps tendon rupture, other causes of shoulder pain should be considered. These include impingement syndrome (rotator cuff bursitis), rotator cuff tears, or fractures around the shoulder.

Rupture of the distal biceps tendon at the elbow joint is much less common and accounts for less than 5% of biceps tendon ruptures. This injury is also usually found in middle-aged patients, although not always. There is usually some degree of tendinosus, or degenerative changes within the tendon, that predisposes the patient to rupture of the tendon.

The significance of a distal biceps tendon rupture is that without surgical repair, patients who experience complete rupture of the distal biceps tendon will notice loss of strength at the elbow. The strength will affect both the ability to bend the elbow against resistance, and the ability to turn the forearm to the palm-up position against resistance (for example, turning a doorknob or screwdriver).

What are the symptoms of distal biceps tendon rupture?

Distal biceps tendon rupture is characterized by sudden pain over the front of the elbow after a forceful effort against a flexed elbow. Usually the patient will hear a snap and have pain where the tendon rupture occurs. Swelling and bruising around the elbow are also common symptoms of distal biceps tendon rupture.

What is the treatment of distal biceps tendon rupture?

Most patients will experience benefit if the biceps tendon is repaired surgically. If the tear is incomplete, or if the patient is very low-demand (not active), then surgery may not be needed. However, most patients who want more normal use of their arm will benefit from surgery to repair the ruptured tendon to the bone.

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