Biceps Tendon Tear at the elbow

Biceps tendon rupture is characterized by rupture of the biceps tendon from the elbow or shoulder joint.

The biceps muscle is the muscle in the anterior side of your upper arm that helps you bend your elbow and rotate your arm.

The biceps tendon is a tough band of connective fibrous tissue that attaches your biceps muscle to the bones at the shoulder and the elbow.

Frequent overuse and injury leads to fraying of the biceps tendon and eventually could rupture the biceps tendon.

Biceps tendon rupture can either be partial or complete. In complete biceps tendon rupture, the biceps tendon will be completely torn away from the bone. Biceps tendon ruptures occurring at the shoulder joint are known as proximal biceps tendon ruptures, and biceps tendon ruptures occurring at the elbow joint are known as distal biceps tendon ruptures.

On the front of the upper arm, the biceps muscle extends from the shoulder to the elbow. The biceps muscle has two tendons at the upper end that attach it to the shoulder bones. The long head attaches to the top of the glenoid and the short end attaches to a projection at the shoulder blade known as the coracoid process.

Causes

Biceps tendon rupture occurs mostly in people of age group of 40 to 60 who have developed micro tears from degenerative changes. Injury and overuse are often the most common causes of biceps tendon rupture in younger people. Falling hard on an outstretched arm, lifting heavy objects while at work or weightlifting, long time use of corticosteroid medications and nicotine dependence are also associated with biceps tendon ruptures.

Symptoms

The most common symptoms experienced by a patient with proximal biceps tendon rupture include:

• Sharp pain in the upper arm
• Tenderness and pain at the shoulder and elbow
• Trouble turning the arm palm up or palm down
• A popping sound in the upper arm
• A bulge at the upper arm above the elbow (also known as positive Popeye sign).
• Bruising to the upper arm

Diagnosis

Your doctor diagnoses biceps tendon rupture after observing your symptoms and medical history. You may be asked to perform simple exercises in order to see which movements elicit pain or weakness. In addition to physical examination, imaging studies such as X-rays or MRIs may be ordered to obtain a detailed view of the biceps muscle and the shoulder joint.

Treatment

Nonsurgical Treatment: Nonsurgical treatment is an option for patients whose injury is limited to the long head of the biceps tendon.

Nonsurgical treatment includes:

• Rest: A sling is used to rest the shoulder. In addition, you are advised to avoid heavy lifting and overhead activities.
• Ice: Applying ice pack 20 minutes at a time, 3 to 4 times a day, helps reduce swelling.
• Medications: Non-steroidal anti-inflammatory medicines help reduce the pain and swelling.
• Physical and occupational therapy: Strengthening and flexibility exercises help restore strength and mobility to the shoulder joint.

Surgical Treatment

Surgery may be indicated for patients who have failed conservative measures. Some of the minimally invasive procedures available for biceps tendon rupture include:

Direct Repair: Direct repair surgery is performed soon after the rupture of the biceps tendon as it reduces the risk of tendon retraction. During a direct repair the surgeon pulls the torn end of the distal biceps tendon through an incision just above the elbow and reattaches it by suturing it to the rim of the radial tuberosity.

Suture Anchor Method: When the biceps tendon ruptures off the forearm bone (radius) it retracts up the upper arm. A small incision is made over the point of attachment of the biceps tendon on the upper forearm. The retracted biceps tendon is pulled through this incision and secured with suture anchors at the radius.

Tension Slide Technique:Tension slide technique makes use of a cortical button for the repair of the torn biceps tendon. The tensioning technique draws the tendon to the distal cortex of the bone socket. The tendon is pulled and attached to the elbow bone and pinned to the bone using a cortical button.

Complications Biceps tendon repair surgery is minimally invasive and is often considered safe. One of the rarest complications includes re-rupture of the repaired tendon.

However, serious medical problems due to biceps tendon rupture can lead to ongoing health concerns, prolonged hospitalization, and rarely death. As with any surgery there are potential medical complications involved. These include:

• Risks of anaesthesia
• Infection
• Allergic reaction to medications
• Blood loss requiring transfusion with its low risk of disease transmission

Recovery

• Pain medicines are prescribed to manage pain.
• A shoulder sling may be recommended for several weeks.
• A rehabilitation program consisting of physical and occupational therapy may also be advised to restore motion and for further strengthening of the muscles.