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Rupture of the Biceps Tendon

The biceps muscle is an important muscle in the upper limb and its function is essential for normal functional activities of the arm. The biceps muscle has two parts near the shoulder which originate in close but distinctly different areas on the shoulder blade near the shoulder joint. The muscle passes down the front of the arm and becomes a tendon near the elbow, eventually inserting into the forearm bone of the radius. The function of the biceps is to bend the elbow and to turn the palm and forearm upwards (supination).  The most commonly affected area to rupture is one of the upper tendons known as the long head, which originates just above the shoulder socket.

This upper tendon makes up over 90% of the tendon rupture of the biceps and tends to occur in and occurs more commonly in the dominant arm and in men, which may reflect the stresses put upon the arm in jobs and activities. People with pre-existing shoulder problems and who are aged between forty and sixty are most commonly affected, likely secondary to degenerative processes going on in the shoulder where the long head resides. Tendons can be ruptured in younger people but this usually results from a traumatic incident with significant forces involved.

In the acute phase of the injury the person experiences some pain in the shoulder region and down the front of the arm, but this quickly settles and they are left with some weakness of shoulder and elbow movements. Onset may be sudden with immediate pain over the front of the shoulder with the person feeling a snap or a pop as the tendon goes. The process can be less clear with intermittent pain on activities or a more general ache in the area, with some patients not complaining of any pain at all.

The physiotherapist examines the arm and can usually easily see and feel an enlarged lump in the mid or lower biceps area as the muscle has contracted down due to the loss of one of its upper fixings. The ranges of movement of the shoulder and elbow will be checked and the muscle strength of all the nearby muscles tested. Initially rest and ice will be the best treatment with anti-inflammatory tablets to control pain and inflammation. As the pain settles the ranges of motion of the shoulder and elbow can be progressed towards normal. Surgical management can be successful if necessary and physiotherapy management of the surgical protocols is essential.

 

Author: Jonathan Blood-Smyth

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