Therapy
Several options are available for the treatment of a biceps tendon rupture. When deciding on the final therapy, the doctor mainly depends on the affected tendon, the patient’s age and the existing limitation. However, cosmetic changes can also be decisive in the decision to undergo surgery.
If the long biceps tendon is affected, a basic decision must be made as to whether surgery is necessary or not. Elderly people who can continue to cope with their everyday life with a slight reduction in the strength of the biceps and can accept the changed appearance of the upper arm are typically treated conservatively, i.e. without surgery, due to the increased surgical risks associated with old age. The upper arm is immobilised in a bandage for about 6 days and then a slow movement is carried out.
The permanent loss of strength when lifting and turning the forearm is then usually only slight (up to 20%). Younger people and athletes, on the other hand, should undergo an operation that almost completely restores the original degree of strength. During the operation, an incision is made at the front of the shoulder and the tendon is prepared freely.
It is then fixed either to the humerus (partly with the help of drill channels) or to the short biceps tendon. Only in a few cases is the torn tendon still long enough to be reattached to the shoulder. Sometimes it may be necessary to remove the remaining part of the tendon from the shoulder (e.g. in the case of a pinch-off) in an arthroscopy.
If the distal tendon is torn, a surgical procedure is almost always chosen due to the severe limitation in flexion and outward rotation of the forearm, which would largely remain without surgery. A small incision is made in the crook of the arm and the torn tendon is located. It is then fixed to the spoke as stably as possible.
This can be done directly by suturing to the bone or using stabilising anchors. If the operation is performed on a torn tendon that has already existed for weeks, transplantation of the tendon of another, less important muscle may be necessary. Typically, operations on biceps tendons are performed under general anaesthesia.
In addition, local anaesthesia of the nerve plexus of the arm can be performed to reduce pain. This takes place at the neck, because the nerves move from there to the arm. A drainage, i.e. a tube with a collecting vessel at the outer end, is often placed in the wound.
It is used to drain off the wound fluid and thus reduce swelling in the operated area. Exercises should be applied to maintain the mobility of the arm and to strengthen and train the remaining musculature. It should be noted, however, that after a biceps tendon tear near the shoulder, no exercises should be performed for at least one week, and after a tendon tear near the elbow for at least four weeks.
After the rest period, strengthening and stretching exercises can be performed. To stretch the biceps, for example, the hands can be brought together behind the back with the palms pointing to the floor. In this position, the arms are stretched upwards until a stretching of the biceps is felt.
For strengthening, the arms are stretched out to the side at shoulder level and in the stretched state are lifted above the head and lowered again to shoulder level. At the beginning the exercise should be repeated 15 times and increased in the course of time. The exercise can be supplemented by weights bit by bit.
To maintain mobility in the shoulder joint, circular movements of the shoulders and arms can be performed. The exercise is performed in a standing position, with the arms hanging next to the body. To train the distal biceps tendon, bending exercises in the elbow and rotation exercises of the forearm should be performed. Sports such as yoga and Pilates are also beneficial for strengthening, stretching and mobility in the arm and can support faster healing.
