What is a Biceps Tendon Injury?

A bicep tendon injury consists of inflammation or tearing of the bicep tendon. Tendons are strong bands of tissue that connect a muscle to a bone. A bicep tendon injury can be acute or chronic. An injury can cause a partial or complete tear of the tendon. A bicep tendon tear typically occurs where the tendon attaches to bone at either the elbow joint or the shoulder joint. If the tendon tears away from the elbow, the injury is known as a distal bicep tear. If the tendon tears away from the shoulder, the injury is known as a proximal bicep tear. Dr. Cunningham is a shoulder specialist at Vail Summit Orthopaedics. He is an expert at diagnosing and treating bicep tendon injuries for patients in Vail, Summit County, Aspen, and Denver, CO.

What Causes Pain in the Middle of the Bicep?

Pain in the bicep is most frequently due to bicep tendonitis or a bicep tendon tear. Overhead athletes or workers who do physical labor are susceptible to developing pain and tearing of the bicep tendon. Overuse can create micro tears of the bicep tendon and the tears typically progress over time. In some cases, a rotator cuff tear or tendonitis may create radiating pain into the middle of the bicep muscle.

How Do I Know I have a Biceps Tendon Injury?

For a bicep tendon injury, symptoms can include:

  • An audible “pop” upon injury
  • Immediate and severe pain
  • Swelling or bruising in the front of the elbow or the upper arm
  • Decreased ability to turn the palm upward
  • Weakness in bending the elbow
  • A palpable gap in the front of the elbow in the case of a complete distal bicep rupture
  • A “popeye deformity” with the biceps muscle having fallen down the arm in the case of a complete proximal bicep tendon rupture
  • Difficulty or inability to lift the arm above the shoulder
  • Pain to the touch at the front of the shoulder or front of the elbow
  • Inability to perform all normal arm activities

How to Treat a Torn Bicep?

It is important to first have a physical exam done by an orthopedist. During the physical examination, a deformity at the elbow or shoulder will be noted.  Shoulder and elbow range of motion and strength will be assessed, particularly the ability to rotate the forearm against resistance compared to the uninjured forearm.

An xray of the shoulder and/or elbow is usually ordered to rule out an associated fracture. An MRI may also be ordered to determine if the bicep tear is full or partial thickness or to assess for other associated injuries, such as an associated rotator cuff tear in the shoulder. For an inflamed bicep tendon or for partial thickness tearing of the bicep tendon, non-surgical treatment is typically recommended. This consists of:

  • Rest
  • Icing
  • Avoiding heavy lifting
  • Pain management
  • Physical therapy
  • Occasionally an injection (steroid or platelet rich plasma)

For patients with partial thickness bicep tears who do not see an improvement in symptoms after trying conservative treatments, surgical treatment may be considered.

Does a Torn Bicep Require Surgery?

Isolated, proximal bicep tendon tears may not require surgery depending on a patient’s age, activity level, and severity of symptoms. Older, more sedentary patients can often have their proximal bicep rupture treated non surgically, with the expectation that they will not have long term pain or loss of function. However, proximal bicep tendon ruptures in older patients are often associated with rotator cuff tears, and these usually require surgery as these will not heal and will worsen over time. Younger patients with isolated proximal bicep tendon ruptures often require surgery in order to restore full strength and prevent chronic pain. Surgery consists of anchoring the biceps tendon into a groove at the top of humerus bone where the tendon normally sits.

Distal biceps tendon tears almost always require surgery as they do not heal, and most patients will continue to experience weakness and a crampy pain in their bicep without surgery. Moreover, the longer one waits for surgical repair, the harder the surgery is to perform and often the results of surgery are not as good. In distal bicep tendon repair surgery, the biceps tendon is reattached to its normal attachment site on the tip of the radius bone at the elbow.

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How Do I Prevent a Biceps Tendon Injury?

Preventative awareness and habits are the key to avoiding biceps tendon injuries. Many cases of tendonitis may be prevented with these strategies:

  • Avoid overuse
  • Limit the number of repetitions that load the biceps
  • Limit heavy loads across the arm and shoulder
  • Stop activities causing bicep pain
  • Avoid poor technique during sports or work

Most notably, any discomfort, ache, pain, or tenderness in the shoulder and upper arm–whether immediate or slowly developing–should be a signal to lessen demand to the shoulder as a first step in preventing a biceps tendon injury. Dr. Cunningham is a shoulder specialist at Vail Summit Orthopaedics. He is an expert at diagnosing and treating biceps tendon injuries for patients in Vail, Summit County, Aspen, and Denver, CO. Contact Dr. Cunningham today.

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