Editors: Frassica, Frank J.; Sponseller, Paul D.; Wilckens, John H.
Title: 5-Minute Orthopaedic Consult, 2nd Edition
Copyright ©2007 Lippincott Williams & Wilkins
> Table of Contents > Biceps Tendon Rupture
Biceps Tendon Rupture
Michael S. Bahk MD
BasicsDescription
-
The biceps tendon can rupture proximally near the shoulder or distally near the elbow (1).
-
Most ruptures occur proximally.
-
-
Proximally, the biceps helps depress and
stabilize the humeral head, whereas distally it is the primary
supinator of the forearm and assists in elbow flexion.
Epidemiology
Incidence
-
Typically occurs in males >40 years old
-
These injuries can be seen in young athletes, and anabolic steroid use should be investigated.
-
Typically occurs in the dominant extremity
Risk Factors
-
>40 years of age
-
Rotator cuff impingement
-
Anabolic steroids
Pathophysiology
-
Tendon degeneration, symptomatic and asymptomatic, is thought to be the cause of biceps tendon ruptures (2).
-
Proximally, degeneration from decreased vascularity or from mechanical impingement from the coracoacromial arch
-
Distally, the degenerated tendon usually
avulses from the radial tuberosity when a large extension force is
applied to a flexed elbow.
-
Associated Conditions
Rotator cuff disease
DiagnosisSigns and Symptoms
History
-
Patients may complain of anterior shoulder, arm, or antecubital pain.
-
Patients may have antecubital elbow pain with forearm supination or flexion.
Physical Exam (3)
-
Ecchymosis and swelling may be present in the antecubital fossa, arm, or shoulder.
-
The retracted biceps muscle belly presents as a large distortion of the arm (“Popeye sign”).
-
Muscle retracts away from the tendon tear.
-
-
Some weakness or pain may present with supination or flexion.
Tests
Imaging
MRI is the best diagnostic study for biceps tendon rupture.
Differential Diagnosis
-
Rotator cuff impingement
-
Rotator cuff tear
TreatmentGeneral Measures
-
For proximal tears, treatment initially is nonoperative.
-
Patients who sustain these injuries often are >40 years old with minimal functional deficits or weakness.
-
Patients <40 years old or those who
are athletes, who are concerned about cosmesis, or who wish an optimal
return of function can consider surgery.
-
-
For distal lesions, surgical repair offers the best functional result.
-
Nonoperative treatment may result in activity-related pain and decreased strength in flexion and supination.
-
Physical Therapy
-
Acutely, rest is recommended until pain and swelling resolve, followed by gentle ROM.
-
Advance activity as tolerated.
Medication (Drugs)
NSAIDs and acetaminophen are recommended acutely.
Surgery
-
Proximal tears:
-
For isolated tears, the biceps tendon is tenodesed in the bicipital groove.
-
If associated with rotator cuff disease, acromioplasty is performed in addition to the tenodesis.
-
-
For distal tears, the biceps tendon is reattached to the radial tuberosity through 1 or 2 incisions.
P.37
Follow-upPrognosis
-
In general, patients undergoing surgical repair of distal tears can expect a near-full return of strength.
-
Patients with proximal lesions treated with tenodesis can expect pain relief.
Complications
-
Without surgery:
-
Some patients may continue to experience activity-related pain.
-
Patients can expect a loss of supination strength.
-
References
1. Strauch
RJ, Michelson H, Rosenwasser MP. Repair of rupture of the distal tendon
of the biceps brachii. Review of the literature and report of three
cases treated with a single anterior incision and suture anchors. Am J Orthop 1997;26:151–156.
RJ, Michelson H, Rosenwasser MP. Repair of rupture of the distal tendon
of the biceps brachii. Review of the literature and report of three
cases treated with a single anterior incision and suture anchors. Am J Orthop 1997;26:151–156.
2. Yamaguchi
K, Bindra R. Disorders of the biceps tendon. In: Iannotti JP, Williams
GR, Jr, eds. Disorders of the Shoulder: Diagnosis and Management.
Philadelphia: Lippincott Williams & Wilkins, 1999:159–190.
K, Bindra R. Disorders of the biceps tendon. In: Iannotti JP, Williams
GR, Jr, eds. Disorders of the Shoulder: Diagnosis and Management.
Philadelphia: Lippincott Williams & Wilkins, 1999:159–190.
3. Curtis AS, Snyder SJ. Evaluation and treatment of biceps tendon pathology. Orthop Clin North Am 1993;24:33–43.
Additional Reading
Bennett
JB, Mehlhoff TL. Arm. Section A: Soft tissue injury and fractures. Part
1: Soft tissue injury and fractures of the arm in the adult. In: DeLee
JC, Drez D, Jr, Miller MD, eds. DeLee & Drez’s Orthopaedic Sports Medicine: Principles and Practice, 2nd ed. Philadelphia: WB Saunders, 2003:1171–1191.
JB, Mehlhoff TL. Arm. Section A: Soft tissue injury and fractures. Part
1: Soft tissue injury and fractures of the arm in the adult. In: DeLee
JC, Drez D, Jr, Miller MD, eds. DeLee & Drez’s Orthopaedic Sports Medicine: Principles and Practice, 2nd ed. Philadelphia: WB Saunders, 2003:1171–1191.
Ramsey ML. Distal biceps tendon injuries: diagnosis and management. J Am Acad Orthop Surg 1999;7:199–207.
MiscellaneousCodes
ICD9-CM
727.62 Ruptured biceps tendon
Patient Teaching
-
Patients with proximal biceps tendon tears often have associated rotator cuff or impingement problems.
-
The best functional results, especially with distal tears, are obtained with surgery.
-
Patients should use caution when lifting
heavy objects (e.g., piano, furniture) because they are at risk for a
distal biceps tendon tear.
FAQ
Q: If I have ruptured my biceps tendon distally, must I have surgery?
A:
No. However, you may experience weakness in elbow flexion and, more
commonly, in forearm supination, and you may have difficulty with
simple tasks of daily living such as turning doorknobs or grabbing
heavy objects off a shelf. Strength is best restored through primary
repair of the tendon.
No. However, you may experience weakness in elbow flexion and, more
commonly, in forearm supination, and you may have difficulty with
simple tasks of daily living such as turning doorknobs or grabbing
heavy objects off a shelf. Strength is best restored through primary
repair of the tendon.
Q: If I rupture my biceps tendon proximally, do I need surgery?
A:
No. Because usually only the long head of the biceps tendon ruptures
proximally, strength can still be generated through the short head of
the biceps. Because proximal ruptures can be associated with rotator
cuff disease, the cuff may require surgery.
No. Because usually only the long head of the biceps tendon ruptures
proximally, strength can still be generated through the short head of
the biceps. Because proximal ruptures can be associated with rotator
cuff disease, the cuff may require surgery.