Brief overview
- Treatment: A torn biceps tendon (biceps tendon rupture) is treated conservatively (without surgery) or surgically, depending on the type and severity of the injury.
- Symptoms: The first sign of a biceps tendon rupture is a loss of strength when bending the arm. Other symptoms include pain, swelling, bruising and deformation of the muscle (“Popeye arm”).
- Description: Rupture of one or more biceps tendons
- Causes: Tendon ruptures are usually caused by strain, for example during sport or accidents.
- Diagnosis: Consultation with a doctor, physical examination (visual diagnosis, palpation, X-ray, ultrasound, MRI)
- Prognosis: A certain amount of strength restriction in the arm often remains, but those affected are usually not severely restricted in their everyday movements.
- Prevention: Warm up muscles and joints before sport, avoid jerky movements and prolonged strain on the arms, refrain from smoking, allow injuries to the biceps tendons to heal.
How do you treat a biceps tendon rupture?
Treatment without surgery
The doctor decides on the treatment for a torn biceps tendon together with the patient. Which therapy is used depends on the respective symptoms. Many sufferers feel little impaired in their everyday life, as the strength in the arm is usually only slightly restricted. In most cases, surgery is therefore not necessary for a rupture of the long and short biceps tendon.
Instead, the doctor treats it with conservative measures. First of all, the affected arm needs to be immobilized for a few days with a shoulder-arm bandage until the pain subsides. In most cases, the doctor will also prescribe physiotherapy in which the affected person learns various movement exercises to strengthen the arm and maintain its mobility.
The doctor prescribes pain-relieving, decongestant and anti-inflammatory medication such as the active ingredients ibuprofen or diclofenac to relieve the pain. These are taken as tablets or capsules or applied as an ointment or gel to the painful area several times a day.
In rare cases, the doctor will perform an operation on a rupture of the long biceps tendon, as some sufferers find the remaining muscle bulge (muscle bulge on the forearm, also known colloquially as the “Popeye arm”) cosmetically unpleasant.
Surgery
A torn distal biceps tendon is usually treated surgically. There are various surgical procedures to reattach the torn tendon to the bone (reinsertion). These include suturing, attaching or anchoring to the bone or looping around the bone.
To prevent permanent loss of strength and function in the arm, surgery should be performed as soon as possible.
Surgery for rupture of the long (and short) biceps tendon
In the event of a rupture of the long (and more rarely the short) tendon in the shoulder area and especially if there are other injuries (e.g. rotator cuff tear), the doctor usually performs an arthroscopy.
To do this, he inserts an endoscope (consisting of a flexible rubber tube or a metal tube with a light source, lenses and a camera) into the joint cavity and first removes any remaining tendon remnants from the joint. He then attaches the torn tendon below the shoulder joint to the humerus (for example using a drill and titanium anchor systems) or sutures it to the short biceps tendon.
If the distal (lower) biceps tendon, which lies close to the elbow, is torn, surgery is usually necessary. The surgeon attaches the tendon to the radius (radius), which together with the ulna (ulna) connects the upper arm to the forearm, for example by suturing or anchoring it to the bone.
If the biceps tendon is severely damaged and it is no longer possible to stitch it together, the doctor may replace it with a tendon from another muscle (tendon transplant).
Follow-up treatment
Following the operation, the arm is immobilized using a splint or a functional brace. However, patients are usually able to move their arm again after a short period of immobilization.
Physiotherapy and movement exercises, which the patient performs daily, are used for follow-up treatment. These promote the healing process, keep the arm or shoulder joint mobile and strengthen the muscles.
The load is gradually increased. Heavier loads are usually possible again after around twelve weeks. The biceps tendon needs this time to grow in properly and be able to bear full weight again.
Appointments for check-ups after the operation are important to monitor the progress of healing.
Exercises
After the operation and immobilization of the arm, it is recommended that you stretch and strengthen your biceps and other arm muscles. The following exercises will help you to support the healing process:
Biceps stretch: To stretch your biceps, bring your arms outstretched behind your back while standing. Keep the palms of your hands on top of each other. Now move your arms backwards and upwards until you feel a stretch. Hold the position for ten seconds and repeat the exercise about three times.
Strengthen your biceps: To strengthen the biceps muscles, raise your arms outstretched to the side. Now raise your arms outstretched above your head and lower them again to shoulder height. Repeat the exercise approx. 20 times. To increase the load, perform the exercise later with weights in your hands.
Practicing flexibility: To train the flexibility of your joints, circle each arm alternately ten times forwards and then ten times backwards. To train the lower biceps tendon, stretch your arms out to the side at shoulder height. Now bend and stretch your forearm alternately, palms facing upwards. Repeat the exercise 20 times.
How can you recognize a biceps tendon tear?
Symptoms of a rupture of the long (and short) biceps tendon
Pain is not the main symptom of a rupture of the long (and short) biceps tendon. In many cases, there is only a dull aching pain. What is noticeable, however, is the (usually only slight) loss of strength when bending the arm. Pain in the shoulder, which often persists for several months without treatment, is also possible. In some cases, a bruise (hematoma) and swelling of the upper arm occur.
In addition, the biceps muscle often shifts downwards to form a recognizable ball when the long tendon tears. The resulting muscle bulge on the forearm (also known as Popeye syndrome or Popeye arm) is often not painful, but is often cosmetically unpleasant for those affected.
If the biceps tendon is only torn, there is sometimes pain when rotating the upper arm and when stretching the arms above the head.
Symptoms of a rupture of the distal biceps tendon
If the distal biceps tendon is torn, there is an acute stabbing pain that is often accompanied by a whip-cracking sound. This is usually followed by pain during certain movements of the forearm, such as screwing and lifting movements. This pain often does not subside even if the affected person rests the arm.
If the distal biceps tendon ruptures, the biceps muscle also protrudes upwards and not downwards as in the case of a rupture of the long biceps tendon.
What is a biceps tendon rupture?
A biceps tendon rupture (also biceps tendon tear) is a tear in one or more tendons of the biceps muscle (medically: biceps brachii muscle, colloquially known as “biceps”). Particularly during sport (e.g. weightlifting), the biceps muscle is usually subjected to high loads. Overloading can therefore lead to a torn tendon. The long biceps tendon is particularly susceptible, while the short or distal (near the elbow) tendon is less common.
Anatomy of the biceps
The biceps brachii muscle (Latin for “two-headed arm flexor muscle”) is one of the upper arm muscles. It is located in the front of the upper arm between the shoulder joint and the radius. Together with the brachialis muscle, it is responsible for flexing the forearm at the elbow joint.
How does a biceps tendon tear occur?
Causes of a rupture of the long and short biceps tendon
Tears of the long biceps tendon are usually caused by minor injuries to the tendon (minor trauma) that occur as a result of prolonged strain during sport or physical work. A rupture of the long biceps tendon usually occurs when the tendon is already damaged. In this case, even everyday movements can cause a tear.
High mechanical stress is exerted on the biceps muscle, particularly during sport. A rupture of the long biceps tendon therefore often occurs not alone, but in conjunction with an injury to other soft tissues of the shoulder (for example the rotator cuff).
Causes of a distal biceps tendon tear
A tear in the distal (lower) biceps tendon is often caused by jerky movements without a great deal of force. It usually tears acutely after direct damage. This is the case, for example, when the affected person lifts or catches a heavy object (such as when weightlifting or playing handball).
Overloading or overstretching the biceps tendon during sports such as bouldering (climbing at jump height) also causes a rupture of the biceps tendon in some cases. Falls or a direct blow (for example in an accident) also often lead to a rupture of the distal biceps tendon.
Who is particularly affected?
Biceps tendon ruptures are also favored by doping (taking anabolic steroids) or cortisone injections into the muscle. Smokers also have an increased risk of biceps tendon ruptures.
How does the doctor make the diagnosis?
If a rupture of the biceps tendon is suspected, the GP usually refers the patient to an orthopaedic specialist.
The doctor first conducts a detailed consultation (medical history) about the symptoms and the possible cause of the injury. This gives the doctor an initial indication of whether a biceps tendon rupture is present.
This is followed by a physical examination. He will examine the affected area and palpate it. In most cases, the orthopaedist will quickly recognize that the tendon is torn by the typical deformation of the biceps muscle (e.g. the so-called “popeye arm”) (visual diagnosis).
To rule out a tear in the distal biceps tendon, the doctor performs the so-called hook test. To do this, the patient presses against the doctor’s hand with the bent forearm. The doctor then uses the index finger in the bent arm to feel whether the tightened tendon near the elbow is palpable.
If you have persistent pain in your upper arm or elbow and pain radiating into your shoulder after an injury, consult a doctor as soon as possible.
What is the prognosis?
With or without surgery: after a rupture of the biceps tendon, there may be a reduction in strength when bending and turning the forearm outwards. Early medical treatment is therefore very important. In most cases, however, those affected do not have to expect severe movement restrictions in everyday life after successful treatment.
Even with the most modern surgical procedures, it is not always possible for sufferers to regain full strength in their arm for sport or work. In most cases, however, the biceps tendons and the muscle are able to withstand the demands of everyday life.
Complications after the operation such as bleeding, infections, wound healing disorders, thrombosis, vascular or nerve injuries are also rare.
How can a biceps tendon rupture be prevented?
To prevent damage to the biceps tendons, it is advisable to pay attention to a few things:
- Warm up your muscles and joints with suitable exercises before sport and physical work.
- Do not move your arms jerkily and do not exert prolonged tension on your arm muscles and joints.
- Allow inflammation and injuries to the biceps tendon to heal. Ask your doctor when you can put weight on your arm again and ask a physiotherapist to show you suitable exercises.
- Refrain from smoking.
