A biceps tendon rupture or bicep tear is a complete or partial rupture of a tendon of the

biceps brachii muscle The biceps or biceps brachii ( la, musculus biceps brachii, "two-headed muscle of the arm") is a large muscle that lies on the front of the upper arm between the shoulder and the elbow. Both heads of the muscle arise on the scapula and join t ...

. It can affect any of the three biceps brachii

tendons A tendon or sinew is a tough, high-tensile-strength band of dense fibrous connective tissue that connects muscle to bone. It is able to transmit the mechanical forces of muscle contraction to the skeletal system without sacrificing its ability ...

- the proximal tendon of the short head of the

muscle belly Anatomical terminology is used to uniquely describe aspects of skeletal muscle, cardiac muscle, and smooth muscle such as their actions, structure, size, and location. Types There are three types of muscle tissue in the body: skeletal, smooth, a ...

, the proximal tendon of the long head of the muscle belly, or the distal tendon. __TOC__

Signs and symptoms

When a tendon of the biceps brachii ruptures the muscle belly retracts, meaning that it goes from a lengthened position under tension at two attachments, to a shortened position with a single attachment. This shortened position forms a bulge which is referred to as "Popeye's deformity," due to similarity in appearance to the cartoon character

Popeye Popeye the Sailor Man is a fictional cartoon character created by E. C. Segar, Elzie Crisler Segar. Other signs at the time of injury may include

ecchymosis A bruise, also known as a contusion, is a type of hematoma of tissue, the most common cause being capillaries damaged by trauma, causing localized bleeding that extravasates into the surrounding interstitial tissues. Most bruises occur close e ...

, swelling, and/or a sharp pain accompanied by an audible popping sound. The

pain Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, ...

may persist for prolonged periods of time depending on the response to the individualized treatment plan. Distal tendon rupture will cause significant weakness with respect to forearm supination and flexion, whereas proximal tendon ruptures do not cause significant weakness as a result of their dual proximal tendinous attachments serving as redundancy. BicepstendonRupture - Copy

Diagnosis

Causes

Biceps tendon rupture may occur in patients with pre-existing rotator cuff tears or impingement syndromes, during athletic activities, or in the context of overuse, aging, or the use of

corticosteroids Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are involve ...

Proximal tendon rupture

The most common tendon to be ruptured is the proximal tendon of the long head. Proximal tendon rupture is not assosiacted with a specific mechanism of injury, rather it more often seen in concurrence with rotator cuff tears or impingement syndromes.

Distal tendon rupture

The mechanism of injury for a distal tendon rupture is forced contraction under

eccentric Eccentricity or eccentric may refer to: * Eccentricity (behavior), odd behavior on the part of a person, as opposed to being "normal" Mathematics, science and technology Mathematics * Off-center, in geometry * Eccentricity (graph theory) of a v ...

load. Two examples of forced contraction under eccentric load include mixed-grip deadlifts (one forearm

pronated Motion, the process of movement, is described using specific anatomical terms. Motion includes movement of organs, joints, limbs, and specific sections of the body. The terminology used describes this motion according to its direction relativ ...

and the other

supinated Motion, the process of movement, is described using specific anatomical terms. Motion includes movement of organs, joints, limbs, and specific sections of the body. The terminology used describes this motion according to its direction relative ...

putting the biceps under greater load) and preacher curls. Distal tendon ruptures are more common in males than females. Distal tendon tuptures occur more frequently in the dominant arm.

Treatment

Acute rupture of the distal biceps tendon can be treated nonoperatively with acceptable results, but because the injury can lead to 30% loss of elbow flexion strength and 30-50% loss of forearm supination strength, surgical repair is generally recommended. Complete distal biceps tears are commonly treated with re-attachment of the biceps tendon to its native insertion on the tuberosity of the radius using bone tunnels, suture buttons, or suture anchors. Proximal ruptures of the long head of the biceps tendon can be surgically addressed by two different techniques. Biceps tenodesis includes release of the long head of the biceps tendon off of its insertion on the glenoid and re-attachment by screw or suture anchor fixation to the humerus. Biceps tenotomy consists of simple release of the long head of the biceps without reattachment to the humerus, allowing the tendon to retract into the soft tissues of the proximal upper arm. Degeneration of the tendon can cause partial tears and are rarely associated with a traumatic event. Treatment of a biceps tear depends on the severity of the injury. In most cases, the muscle will heal over time with no corrective surgery. Applying cold pressure and using anti-inflammatory medications will ease pain and reduce swelling. More severe injuries require surgery and post-op physical therapy to regain strength and functionality in the muscle. Corrective surgeries of this nature are typically reserved for elite athletes who rely on a complete recovery. Older patients will be treated by long head bicep tenotomy almost without exception.

Prognosis

References

{{DEFAULTSORT:Biceps tendon rupture Dislocations, sprains and strains Sports injuries