Biceps Tendon Ruptures
(Warning- there are a few medical pictures in this one…if you have a weak stomach DO NOT scroll down)
Well, we got a little off topic last month with the stretching video for Alabama Power (which was a lot of fun, and thanks for the great feedback everybody). Now, I’d like to return to our previous theme – Does it need surgery? The perfect topic came to my mind today because it can be very confusing to people. That is, what do we do for a biceps tear? I can’t tell you how many patients I have had come in saying something like (in my best North-Central Alabama accent), “Doc, I heard a pop and now I’ve got this big a’ risin on my arm. Some of my friends say you have to get surgery, others tell me, naw the doc’s going to tell you to ice it up and get back to work. What’s the deal?”
The deal is this. The biceps tendon can tear at the shoulder or at the elbow. The treatment for the two injuries couldn’t be more different. That is why there is confusion. When the tendon tears at the shoulder it is almost always handled with rest, ice, and anti-inflammatories (conservative care). When the tendon tears at the elbow, it almost always needs surgery.
With biceps tears at the shoulder one usually feels a pop, gets swelling and bruising, and can even have a bit of a “popeye” deformity at the upper arm (see picture below). The biceps tendon starts in two places at the shoulder (thus the name “bi”) – the place that usually tears is called “the long head” and comes from the portion of wing-bone within the shoulder called the glenoid. When torn the tendon slides down into the muscle and fascia of the upper arm. Since it scars there and there is very little power lost in the arm as the result of this tear (most of the actual strength of flexion of the elbow comes from another muscle called the brachialis. The biceps may make a body-builders arm look ripped, but it actually isn’t nearly as powerful a flexor as the brachialis). So, when the tendon tears at this point it is generally felt that surgical repair is not worth the risk. Interestingly, I have had body-builder patients and entertainment wrestlers tear a biceps on one side and then requestthat I do it to their opposite side. They seem to like the popeye look and want to have a matching pair.
When the biceps tears at the elbow it is an entirely different story. Usually this injury presents as a pop or tearing sensation at the elbow in a person doing a fairly heavy-duty activity (like moving a TV or trying to lift an air-conditioner unit). There is painful swelling and bruising at the elbow. Often, the person can continue to function at a fairly high level. The biceps at the elbow provides a great deal of the power of supination strength. That is to say, it is what powerfully rotates the hand and wrist. Think of using a screwdriver and how hard one must occasionally turn the tool in order to get in the last few rotations. The biceps tendon insertion onto the radial bone is what is largely responsible for this power. If a working man or athlete is to lose that power in their dominant arm it can be a big problem. In these cases, surgery is the answer and doing it fairly quickly (within a week or so) is critical. If the tendon retracts up into the arm it can begin to shorten and scar, thus losing the opportunity to fix it without ill-effect.
So, the take home points are: if you feel a pop in your shoulder or elbow you should probably have it looked at by a professional, if you tear your biceps at the shoulder you are likely to have conservative care, and if you tear you biceps at the elbow you are likely to need surgery. I hope this has been helpful. If you have any questions or concerns about this or any other orthopedic issue please don’t hesitate to contact us at the office. Stay Well.