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

Subacromial Bursitis Made Easy

Understanding Shoulder Bursitis

The subacromial bursa is a thin, sac-like structure located just under the acromioclavicular, or AC, shoulder joint. It acts as a lubricating buffer between the rotator cuff, undersurface of the lateral clavicle and scapular acromion process.

Specifically, the bursa’s main function is to reduce friction in 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, it is quite efficient at specifically doing so with respect to the head of the humerus, long-head of the biceps tendon and the (all-important) rotator cuff.  Given the level of motion and stress associated with the shoulder joint, the subacromial bursa certainly faces a trying task every single day. However, this does not even involve direct contact with the shoulder girdle.

Rotator cuff tendonitis and shoulder impingement syndrome are other conditions commonly associated with chronic subacromial bursitis. Additionally, it is not unusual for a chronic rotator cuff injury that alters shoulder joint mechanics to result in subacromial bursa inflammation. It is therefore extremely important to assess for any additional upper extremity or torso imbalances/injuries that require treatment when an athlete presents with 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
  • Symptom escalation generally associated with either a direct blow to the front of the shoulder joint or increased shoulder use, usually involving overhead-type activities
  • A sense of weakness or loss of strength with activities involving the shoulder
  • Localized puffiness or a pocket of swelling in the upper-front area of the shoulder, just below the AC joint, which becomes more evident when the arm is extended at the shoulder
  • Weakness with active shoulder elevation and abduction

Professional Treatment for Subacromial Bursitis

  • Eliminate all routines that contributed to the bursitis. This can include excessive overhead activities, trauma or contact to the shoulder, weight training above shoulder level, painful motion during activities of daily living (ADLs) or carrying heavy objects like luggage with the affected shoulder.
  • Consistently ice the front, top and back of the shoulder.
  • Utilize available therapy modalities to decrease pain and swelling.
  • Do easy pendulum swings with no more than 5 pounds of weight.
  • Perform passive and pain-free range of motion (ROM) shoulder joint exercises, to include flexion, abduction, horizontal abduction and external rotation. At the same time, minimize shoulder extension and horizontal adduction motions.
  • Employ progressive resistive strengthening of external shoulder rotation, if pain free.
  • Avoid sleeping on the affected shoulder if still swollen and/or painful.

Ask the Right Questions Like a Pro

Here’s what smart pro athletes would ask their sports medicine specialist to ensure a fast and safe return to the game they love:

1. Is this an isolated bursitis, or do I need to treat other shoulder issues as well?

2. Is my rotator cuff damaged?

3. What do you believe caused this injury, and how can I avoid these types of injuries in the future?

4. Should I expect future anti-inflammatory injections for this bursa?

Elite Sports Medicine Tips from Mike Ryan

  • Looks Can Be Deceiving – Bursitis often looks worse than it feels.
  • Get it Right the First Time – Don’t let the lack of initial pain fool you – with the bursa’s proximity to the rotator cuff, seek swift, appropriate treatment to avoid a chronic nightmare.
  • Ice, Ice Baby – It’s said time and time again, but the “ice thing” is a key tool to quiet down bursitis and reduce localized swelling.
  • Pinpoint the Source – If the reason for bursa swelling is unknown, dig deeper to find out why.  Quickly finding the source helps avoid major shoulder complications down the road.
  • Avoid the Knife – Some doctors are quick to offer a “simple surgical solution.”  Run away quickly and reread this article.