Biceps Tendon Rupture

``Popeye Muscle``

 What is a biceps tendon rupture?

Biceps tendons attach the biceps muscle to bones in the shoulder and in the elbow. A biceps tendon tear is a tear of the tendon either at the top of the shoulder or at the elbow, leaving the arm swollen, sore and weak.  Biceps tendon tears can be partial tears (like fraying rope) or complete tears. The bicep muscle allows you to flex your elbow and rotate your forearm.

 How does it occur?

 There are two main causes of biceps tendon tears: injury and overuse. The risk factors for possible tear are age, heavy overhead activities, shoulder overuse, smoking, and corticosteroid medications. 

Over time the fraying of these tendons like rope can cause a complete tear of the biceps tendons. The long head of the biceps tendon is more likely to tear because of its passage through the shoulder where it can be affected by rotator cuff tendinitis and impingement syndrome. 

If you are involved in heavy weightlifting, a job requiring heavy overhead lifting, swimming, or tennis you are at risk for injuring and possibly tearing the biceps tendon. Sometimes, with a complete rupture, the biceps muscle will bulge closer to the elbow and be termed a “Popeye muscle.”

What are the symptoms?

You may have a sudden sharp pain, an audible pop, bruising, weakness, or a bulge in upper arm. Turning the palm up (supination) will also be difficult to perform.

How is it diagnosed?

A complete history and physical exam will be performed. The diagnosis is most obvious usually from the deformity of the arm muscle, the Popeye muscle, which will be enlarged.  You will have pain and weakness when you flex your arm at the elbows. X-rays and an MRI are usually performed to confirm the diagnosis and for treatment planning.

How is it treated?

Conservative treatment can be tried such as ice, non-steroidal anti-inflammatory drugs (NSAIDs), rest, and physical therapy. Surgery can be performed for patients with severe pain and cramping and for those who require recovery for strength, such as athletes and manual laborers.  Most people under age 70 who tear the biceps tendon do require them to be fixed.

Biceps tenodesis is the procedure in which a proximal biceps tendon tear at the shoulder is reattached to the proximal humerus bone. This procedure can be done by minimally invasive arthroscopic surgery or as an open procedure depending on the extent of the tear. This is done as a same day surgery; patients rarely stay overnight.  The procedure itself takes about 30 minutes with an average time in the facility of 4 hours total.

If you have a severe tear or complete rupture, it is important to get it treated as soon as possible.  If you wait more than 6-8 weeks to get this fixed, the bicep muscle will contract, making it difficult or impossible to reattach.

What is the recovery time?

Recovery varies based on the extent of the condition and what is actually done at time of surgery. Our patients wear a sling for 24 hours after surgery. After that they remove the sling and start an exercise program which can be done at home. We will evaluate you at your 2 week follow-up appointment and advance your exercise program as appropriate.  We will make recommendations on outpatient physical therapy at that time, however, most of our patients are able to have a full recovery using the home exercise program. Most patients resume light-duty work within a few days and progress to full-duty in 3 weeks to 3 months. The longer you delay surgery, the longer your recovery time will be.

We are here to help. If you believe you are suffering from one of these conditions, we would love to deliver a diagnosis, get you treated and get you moving again.

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