What is a Biceps Rupture?
There are a couple of different ways that the biceps can be injured. One can either injure the biceps up by the shoulder or down by the elbow. When the injury occurs up at the shoulder we refer to it as a proximal biceps rupture. When the injury occurs at the elbow it is called a distal biceps rupture. These two injuries are treated very differently from one another.
Which Biceps Tendon Did I Just Tear?
The more common of the two is the proximal biceps rupture and results in a “Popeye” deformity in the upper arm. The biceps are made up of two muscle bellies (heads) and when the injury occurs proximally it only affects the long head of the biceps. It more commonly occurs in individuals that are in their 70s and 80s but can occur in younger patients as well. The initial presentation is usually a pop that occurs during lifting followed by swelling of the biceps as well as some bruising. It can be fairly uncomfortable initially but the symptoms usually subside over the next week or two.
Do I Need To Get My Proximal Biceps Tendon Fixed?
Most can get along fine with nonoperative intervention for this type of injury. Some may experience a little bit of weakness and cramping particularly if this is their dominant arm and they do a fair amount of lifting. Sometimes proximal biceps ruptures occur when a person also has a rotator cuff tear. When this is the case treatment recommendations may vary. If surgical repair is performed it can be done as an outpatient.
Did I Just Tear My Distal Biceps?
Distal biceps ruptures typically occur in patients in their 40s 50s or 60s. Because the two muscle heads converge into one tendon at the elbow it affects the entire biceps (both heads). It primarily happens when someone is lifting a heavy object. A very common presentation is a pain or pop in the elbow while trying to lift something heavy like a piece of furniture. The patient will almost always feel a pop followed by pain and swelling that occurs in the front part of the elbow called the antecubital fossa. One may notice a deformity of the biceps or a wrinkle in the skin in the front of the elbow.
Even though the bicep has been completely detached patients will usually still be able to flex their elbow. This is because there are other muscles (brachialis, brachioradialis, etc.) that assist with elbow flexion. The most noticeable strength deficit will be with supination which involves twisting of the forearm such as when using a screwdriver or turning a doorknob. The diagnosis is made by physical exam in the office setting. Confirmation of the injury can be done with either an ultrasound evaluation or an MRI.
Should I Get my Distal Biceps Rupture Repaired?
Distal biceps ruptures are almost always treated with surgery. Without surgery one will be left with weakness in the bicep that results in diminished flexion and supination strength. The outpatient procedure s done through one small incision and involves reattaching the tendon to the radial tuberosity near the elbow.
This can be done under a regional anesthetic with sedation. After one week of immobilization, early range of motion is started. A sling or brace is used for about one month. Light progressive strengthening begins about six weeks after surgery. Most patients are completely recovered in about 3-5 months.
If you think you may have ruptured your biceps tendon come in for an evaluation right away. It is best to get it fixed within 3 weeks of the injury. ISMI has extensive experience with the repair and management of biceps tendon ruptures.
To set up an appointment for further evaluation, please call (208) 336-8250.