Pondering Questions After a Biceps Tear

I received a message from a Jags’ season ticker holder with a simple medical question related to a not so simple shoulder injury.  This loyal Jacksonville fan completely tore the proximal long head of the biceps brachii muscle in his dominant arm and he was looking for some direction on how to manage this injury.

As you can imagine, I get many calls from individuals, coaches and parents seeking my opinion for sports medicine issues.

A complete tear of either of the proximal bicep heads or tendons (long head and short head) is not a common injury compared to the more often torn belly of the biceps muscle or the distal insertion of the muscle.  Is there much of a difference in the long head tendon tear compared to “just a biceps tear”?  A Google search for “torn long head of biceps” produces 84,400 results.  A Google search for a much simpler term “torn biceps” generates 938,000 or 11 times as many results!  The bottom line:  a biceps tear is not just another biceps tear.

“Do you think I need surgery?”

Answer:  Not likely.

“Will torn biceps limit my ability to throw and participate in martial arts?”

Answer:  For about 8 weeks, it will limit you considerably.  After that, overhead activities need to be limited as tolerable and his rotator cuff (R/C) activities need to be consistent to maintain his rotator cuff (R/C) strength.

As a 50+ year old athlete with an injured shoulder, the healing time for this gentleman may be longer and the tendon itself will not be as elastic and strong as it was when he was in his 20’s. Does he need to sit on the coach, take a couple of bottles of medicine, rest the arm, let all the muscle of the shoulder and arm get weak for 8 weeks when he revisits his doctor?  No way!!

After extensive listening (a valuable skill for smart physical therapists), asking him to move/assess his arm via detailed instructions over the phone, a thorough medical history and asking him very specific questions, here is what I suggested to him:

1.  Go see an orthopedic surgeon to have your shoulder injury thoroughly examined.

2.  If no surgery is required, start physical therapy to focus on restoring shoulder joint range of motion (ROM).

3.  Get after your R/C aggressively.  A weak R/C with a missing long head of the biceps is predisposed to shoulder impingement syndromes and bursitis injuries.

4.  Re-evaluate your athletic activities.  Overhead strength work, high-intensity bicep strengthening drills and throwing activities are risky and may need to be minimized for the remainder of his life to avoid complications.

5.  Your overall bicep strength will be reduced by 15 to 40%, depending upon  any secondary injuries and the strength of your short head of the biceps.

6.  Don’t underestimate the little things that create big results at your injured shoulder: Posture, upper back strength and hand grip strength.

He was so happy and appreciative for my phone call and advice.  As I always tell those that I give medical advice to:  “I’m not a doctor” but I’ve seen many injuries now that I’ve literally spent the last 1/2 of my life (24 years) working in the NFL.

I’m proud of that fact and I feel privileged to represent the Jacksonville Jaguars.  To make it even better, I’m able to share sports medicine knowledge every day to help improve the lives of both professional and amateur athletes!

Subacromial Bursitis Made Easy

Understanding Shoulder Bursitis

The subacromial bursa is a thin sac-like structure that is located just under the acromioclavicular or AC joint of the shoulder.  The bursa lies over the top of the rotator cuff.  The bursa acts as a lubricating buffer between the rotator cuff and the undersurface of the lateral clavicle and acromion process of the scapular, both of which articulate with each other to form the AC joint.

The subacromial bursa’s main function is to reduce the friction on the upper layers of the rotator cuff and humeral head during shoulder motion.  As a thin fluid filled sac, similar to a slim water-balloon, the subacromial bursa is quite efficient in acting as a friction reducer for the head of the humerus, the long-head of the biceps tendon and the all-important rotator cuff.  With the amount of motion and stress associated with the shoulder joint, the subacromial bursa has a difficult task each and every day even without involving direct contact to the shoulder girdle.

Rotator cuff tendonitis or a shoulder impingement syndrome are commonly associated with chronic subacromial bursitis.  It is not unusual to have a chronic rotator cuff injury which would alters the mechanics of the shoulder joint resulting in an inflammation of the subacromial bursa.  That is why it’s important to determine if there are any additional upper extremity or torso imbalances or injuries that require treatment when a player demonstrates a bursitis involving the shoulder.

Signs & Symptoms of Subacromial Bursitis

  • Generalized stiffness of the shoulder joint, mostly on the top and front of the shoulder.
  • An increase in symptoms generally associated with either a direct blow to the front of the shoulder joint or a significant increase in shoulder activities usually involving overhead-type activities.
  • A sense of weakness or loss of strength with activities involving the shoulder.
  • A localized puffiness or pocket of swelling in the upper-front area of the shoulder just below the AC joint.  This isolated pocket of swelling becomes more evident when the arm is extended at the shoulder.
  • Active shoulder elevation and abduction demonstrates weakness.

Professional Treatment for Subacromial Bursitis

  • Eliminating all activities that contributed to the bursitis such as excessive overhead activities, trauma or contact to the shoulder, weight training above shoulder level, painful motions during activities of daily living or hanging heavy object like luggage on the involved shoulder.
  • Consistent icing of the front, top and back of the shoulder.
  • Utilization of the necessary therapy modalities to decrease pain and reduce swelling.
  • Easy pendulum swings with no more than 5 lbs.
  • Passive and painfree range of motion (ROM) of the shoulder joint to include flexion, abduction, horizontal abduction and external rotation while minimizing the motions of shoulder extension and horizontal adduction.
  • Progressive resistive strengthening of shoulder external rotation, if painfree.
  • Avoid sleeping on this shoulder while swelling and/or pain remains.

Asking the Right Questions Like a Pro

Here’s what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports:

  1. Is this an isolated bursitis or do I have other shoulder issues that I need to treat?
  2. Do I have any damage to my rotator cuff?
  3. In your opinion, why did I get this injury and how can I avoid these types of injuries in the future?
  4. Will I need to have this bursa injected with any anti-inflammatory medication in the future?

Elite Sports Medicine Tips from Mike Ryan

  • Looks Worse – Bursitis often looks worse than it feels.
  • Treat Right the First Time – It may not hurt at first but with it’s proximity to the rotator cuff, you don’t want it to spoil the party in the should and become a chronic nightmare.
  • Ice is Key – I know I wear out the “ice thing” but it’s a key tool to quiet down bursitis cool and to reduce localized swelling.
  • Find the Source – If the reason for the bursa swelling is unknown, dig deeper to find out why.  Find the real reason often avoids major shoulder complications a couple of weeks from now.
  • Avoid the Knife – Some will quickly offer a “simple surgical solution”.  Run away as fast as possible and reread this article.