Biceps Tendon Ruptures (proximal)

What is a biceps tendon rupture?

The biceps is a muscle with 2 proximal originations for the 2 heads of the biceps. The long head is one of only 2 intra-articular (within the joint) tendons in the body. The long head of the biceps tendon originates at the top of the labrum and runs through a small space in the rotator cuff and into a bony groove. This tendon can become torn or damaged, and may rupture or tear completely. When this occurs, this is will cause initial pain, swelling and bruising, often followed by improvement in shoulder pain. Because the long head of the biceps has ruptured and is now able to slip down the arm, the biceps muscle shape will be altered, having a more rounded or "Popeye" appearance.

Biceps tendons can also tear at the insertion near the elbow; these are called distal biceps tendon ruptures. This is much more likely to require surgery than if the tendon ruptures at the long head origin in the shoulder.

What causes a biceps tendon rupture?

The biceps tendon (long head) is subject to the same forces as the rotator cuff, and can become worn, frayed or damaged over time. Alternatively, the biceps can be injured with a forceful contraction of the muscle.

How is a proximal biceps tendon rupture diagnosed?

Typically the diagnosis is made based on history and examination. People will generally report that they felt a pop in their shoulder, that the developed some bruising and pain. Some will report that after the pop, the shoulder pain actually improved. This occurs because the painful, damaged tendon has slipped down out of the shoulder and is no longer being repeatedly pinched and frayed.

In some patients, an MRI is needed to evaluate whether the rotator cuff has also torn in addition to the biceps tendon.

How is a proximal biceps tendon rupture treated?

A biceps tendon rupture in isolation is often treated nonoperatively. Younger age, heavier workload, and involvement of the dominant arm are relative indications (reasons) to consider surgery. Biceps tendon ruptures can occur in conjunction with rotator cuff tears; in these cases the rotator cuff may need to be addressed surgically.

What happens if surgery is necessary?

The biceps tendon can be tenodesed (secured) to the arm bone (humerus) in a variety of ways. A small incision on the arm is usually necessary to locate and secure the biceps tendon. This will often be performed in conjuction with shoulder arthroscopy to evaluate and treat any other problems in the shoulder joint. However, for many patients it is best to live with a long head biceps rupture, as strength and function of the arm are typically preserved.