Proximal biceps brachii tendon ruptures (bicep rupture) are more common than most would assume. High intensity athletes, especially in contact sports, are prone to this injury.
These cases are predominantly injuries to the long head of the biceps brachii compared to the short head. This is due to the fact that the long head is more vulnerable because it passes over the shoulder joint to its attachment at the top of the glenohumeral joint
A biceps tendon rupture involves a rather longitudinal laceration along the tendon of the long head. This vulnerable tendon attaches a group of fibers from the belly of the biceps muscle superiorly at the shoulder joint itself.
It is seen mostly among active individuals as a direct result of repetitive shear forces that originate at the attachment. This injury is commonly linked to high force weight lifting activities with determined athletes trying to get to the top of their game.
Fractures can sometimes be a factor, especially when stress fractures are located at the neck of the upper arm or humerus bone. The tears can be partial or complete. Untreated partial tears of the long head of the biceps can progress into complete tears. Secondary complications such as an impingement syndrome, a rotator cuff tendon tear, and labral tears can be directly related to chronic proximal bicep issues.
At the time of a long head tendon rupture, the athlete may feel/hear a pop or snap but it is often not overly painful.
Be sure to confirm the injury is indeed a tendon tear and not a topical tendon inflammation (tendinitis) as these two could present with similar signs and symptoms.
Signs and Symptoms of a ruptured long head of Biceps brachii muscle
- A “spasm bulge” in the lower part of the arm. This is due to the biceps brachii muscle belly involuntary contraction without its regular check by the long head tendon attachment above the shoulder joint. The intact short head is able to keep the muscle in position but not overly effective.
- A localized sharp pain originating in the front of the shoulder and radiating in a downward direction to the muscle belly.
- An audible pop or snap at the time of injury.
- Rapidly fatiguing biceps muscle with activity.
- Pain, tenderness, weakness and considerable difficulty eliciting shoulder and elbow movements.
Professional Treatment for Ruptured tendon of long head of Biceps brachii
- Rest the shoulder and elbow joints while consistently icing the anterior shoulder and upper arm to minimize both swelling and pain.
- Avoid strenuous arm activity for at least two weeks.
- Utilize the latest physical therapy modalities and rehab devices to reduce swelling and decrease pain.
- Increase your consumption of Vitamins C to assist your body’s ability to produce fibroblasts, which synthesizes the ever-important collagen. The production of effective collagen requires Vitamin C.
- Restore flexibility and range of motion of the shoulder joint, shoulder girdle and elbow joint.
- Discuss options with your physician. The non-operative approach is the typical plan but surgical options are considered when specific issues such as past medical history, intended level of activity, degree of limitations and patient’s intentions merit the need for surgery.
- As the range of motion and pain improve, progressive resistive (strengthening) exercises should be integrated into the rehab plan. Isolated bicep curls and resistive shoulder flexion exercises are watched closely and progressed more slowly compared to other motions due to the stress on the shoulder joint.
- Be diligent with your physical therapy program, which should include strengthening, flexibility, proprioception, and cardiovascular exercises.
Asking the Right Questions like a Pro Athlete
Here’s what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports:
- Is this a ruptured tendon of my biceps muscle or a partial tear of the tendon?
- Do I need more diagnostic procedures to rule out other injury possibilities?
- Do I have any secondary damage to any other structure around my shoulder?
- Do you think I need to have surgery for this injury? If not, what are the short term and long term risks of conservatively treating this injury?
- Where are your top three physical therapy recommendations to rehabilitate this injury?
- In your opinion, what is the timeframe for me to return to my usual routine?
Elite Sports Medicine Tips from Mike Ryan
- Relax – The right frame of mind will prove to be a helpful tool with this type of an injury. A well-managed ruptured tendon will allow you to return to your normal activities quite quickly.
- Be extra diligent with Rehab– Nothing should hinder you from following through with your physical therapy plan.
- Realize the Risks – The reality is that if you fail to rehab your shoulder/arm properly, the altered mechanics of the shoulder may predispose you to potential injuries such as an impingement syndrome, bursitis, tendonitis and early arthritis.
- Avoid complicating the joint – Thoroughly evaluate your daily routine and avoid activities that aggravate your biceps muscle and shoulder joint to stress that would slow your progress.