The biceps muscle is the large muscle in the front of the upper arm. It is attached by a strong tendon at the top in the shoulder and below at the elbow. When a tendon is worn and prone to injury, a very intense contraction of the biceps muscle can cause this tendon to rupture and detach. Since the muscle can no longer pull on the bone, certain movements may be weakened.
There are two types of biceps tendon ruptures, proximal and distal. With a proximal biceps tendon rupture, the injury is to the biceps tendon at the shoulder joint. This “wear and tear” injury is most common in patients over 60 years and often causes minimal symptoms.
The distal biceps tendon is an injury to the elbow joint. Seen more often in middle-aged men, it can be the result of heavy lifting or sport injuries. An MRI may be ordered by the physician to confirm the findings.
Treatment Options for Biceps Tendon Rupture
- Nonsteroidal Anti-inflammatory Medication Dr. Hecht may prescribe an anti-inflammatory medication for a period of time to calm/lessen the pain caused by the inflammation.
- Corticosteroid Injections Occasionally a cortisone injection is used to locally treat the inflammation in the shoulder joint. Dr. Hecht will discuss the risks and benefits of cortisone injections with you.
- Surgery If non-operative treatments fail to improve symptoms, surgery can be performed. For patients with proximal biceps tendonitis prior to rupture, two options exist – both are usually performed arthroscopically. The first involves cutting the biceps tendon at its origin on the shoulder socket. This is known as a “biceps tenotomy.” This is usually reserved for older, lower demand patients. The second, known as “biceps tenodesis,” involves cutting the biceps and reattaching it to another portion of the arm bone, or humerus. This is usually performed in younger, more active patients.
- Distal Biceps Surgery – If a complete tear of the biceps tendon at the elbow is diagnosed, surgery may be recommended to reattach the tendon to the bone. This is performed through an open incision on the front of the elbow when patients desire full strength, function, and symmetric appearance to their arms.
- Strengthening exercise and PT after surgery A successful outcome with surgery is dependent upon a dedicated and supervised rehabilitation program. Patients are referred to physical therapy where they work one-on-one with a licensed physical therapist 2-3 times/week to regain range of motion, strength, and the ability to perform desired activities. The overall length of physical therapy varies depending on the procedures performed.
Why Dr. Joseph Hecht?
Dr. Hecht is board certified in orthopedic surgery, providing expert knowledge and expertise in the area of shoulder conditions and treatment options. As one of the top Northwest Indiana and Chicagoland shoulder surgeons, Dr. Hecht brings years of valuable experience to every shoulder assessment.
Tips for Healthy Shoulders
To avoid experiencing shoulder pain, patients should keep physically fit with a balanced program of aerobics, stretching and strengthening all body parts to help to prevent shoulder injuries. If you think you have injured your shoulder, consult a board-certified Orthopaedic physician or physical therapist before starting an exercise program. Here are some specific tips for the shoulders:
- Apply heat to shoulder muscles before exercise. Heat prepares muscles and tendons for exercise.
- Keep your arm below shoulder height while doing stretches for the shoulder.
- Gradually increase movements—big circles, across-body movements, trunk twists, shoulder blade rolls and forward and backward squeezes—during shoulder warm-up.
- Pendulum stretching exercises relieve pressure on the rotator cuff. While sitting or standing, keep arm vertical and close to the body. Allow arm to swing back and forth in a small diameter (about 1 inch). As symptoms improve, the diameter of swing may be increased. Initially perform the exercise with just the weight of your arm. As shoulder pain improves, progressively add more weight—5 to 10 pounds (a filled gallon container weighs 8 pounds). Perform exercise for 5 minutes once or twice a day.
- Muscle-strengthening exercises can be performed about 1 to 2 weeks after doing pendulum stretching exercises. Use elastic exercise bands for a variety of arm exercises. For example, attach band to a doorknob. Then hold your elbow close to your side at a 90 degree angle, grasp the band and pull toward your waist. Hold for 5 seconds. Do 15 to 20 repetitions each day.