Bicep Tendon Rupture

Photo of a man with drawn on muscles for arms.
Rupture of your biceps can limit your normal use of your arm. Jessica Peterson/Getty Images

The bicep brachii muscle is one of the major flexors of the elbow joint. In other words, this muscle allows us to bend our elbow to lift objects and perform daily tasks. The biceps muscle is also responsible for turning your hand over so it is palm up. (Don't believe me? Try it. Turn your hand over a few times while watching the front of your upper arm. You can see your biceps muscle in action while you turn your hand over.)

Anatomy of the Biceps Muscle

The bicep brachii muscle divides into two muscular portions slightly above the mid portion of the arm, and thus its proximal bony attachment is formed by two separate tendons, the long head and short head bicep tendons. Each tendon has a separate insertion site. The long head bicep tendon originates from the supraglenoid tubercle of the scapula, and the short head tendon from the coracoid process of the scapula. The distal tendon of the bicep brachii muscle inserts on the radius bone of the forearm.

Rupture of the Biceps Tendon

Rupture of the proximal bicep tendon accounts for around 95% of all bicep tendon ruptures with almost always exclusive involvement of the long head muscle tendon.

Rupture of the bicep tendon can be caused by several different mechanisms. Acute tears are caused by excessive loading or rapid stressing of the elbow joint such as during weightlifting activities.

Partial tears can be the result of chronic impingement and fraying of the tendon under the acromion of the scapula and can also occur along with rotator cuff injury.

Symptoms of Biceps Tendon Rupture

Symptoms of biceps tendon tears include sudden sharp pain felt in the upper arm. There is also tenderness to palpation at the shoulder joint.

An audible snap can occasionally be appreciated. A soft mass may be felt in the upper arm, and is a result of the muscle belly rolling up on itself.

Diagnosis of this disorder includes a physical examination by your physician as well as imaging studies if needed. There are several specialized tests that can evaluate and assist in making the diagnosis of a bicep tendon tear. The simplest test for biceps tendon rupture is called Popeye sign. Simply look at your arm with the suspected tear. The tendon and muscle will be balled up just above your elbow and look like an arm of Popeye the Sailor Man. This typically indicates that your bicep is torn.

Physical Therapy for Biceps Tendon Rupture

Conservative therapy for biceps tendon rupture includes initially limiting activity of the involved extremity, non-steroidal anti-inflammatory medications, as well as a comprehensive physical therapy program. Your physician will make the decision as to whether surgical repair is necessary. Typically, surgery is only performed as a cosmetic procedure; your arm can function normally if one head of your biceps tendon is ruptured as long as the other biceps head remains.

Your PT can assess your condition and check your shoulder and elbow range of motion and strength. Typically a loss of rotator cuff and shoulder strength is seen with a biceps tear. Exercises to improve the way your shoulder and arm function are typically prescribed. Your PT may progress you from shoulder active ROM exercises to shoulder strengthening exercises with a resistance band.

After a biceps tendon rupture, you can expect to return to your previous level of activity within 4 to 6 weeks. Your PT can help you restore normal functional use of your arm. If you suspect you have a biceps tendon rupture, check in with your doctor, and then visit your PT to quickly and safely get back to your normal activity.

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