If you’ve ever injured your shoulder or upper arm, you know how painful and even debilitating those types of injuries can be.
If you have injured or are experiencing pain in or around your bicep, there are several possible issues that you could be dealing with, including a biceps tear.
If you suspect that you have a torn bicep muscle, biceps tendon rupture, or any related issue, contact your orthopaedic surgeon as soon as possible.
For some background, the biceps are a muscle located at the front of the upper arm, connected to the scapula bone in the shoulder by two tendons and the radius bone in the elbow by one tendon.
This muscle and associated tendons control the shoulder and the elbow and how the two joints interact with each other.
You may have heard of it referred to as the “Popeye muscle” after the beloved cartoon character with impressive biceps.
What is a bicep tear?
A bicep tear or rupture occurs when one of the tendons connecting the bicep to the bone becomes frayed or damaged, and eventually tears.
Torn biceps usually happen either as a result of constant and consistent overuse or a serious and traumatic injury.
Bicep tears occur at the shoulder and the elbow, and the tears can be complete or partial; a complete tear happens when the tendon has completely separated from the bone while in a partial tear some of the tendon is still connected to the bone.
The two types of shoulder biceps tears
There are two different types of biceps tears, shoulder or proximal biceps tears and distal biceps tendon tears.
Proximal biceps tears occur when one of the two tendons that connects the biceps muscle to the shoulder – either the “long head” tendon that attaches the bicep to the top of the scapula or the “short head” that attaches the biceps muscle to the front of the shoulder socket (on the coracoid bone) is fully or partially torn (note that most biceps tendon tears occur in the long head tendon).
Tears of the short head of biceps tendon are extremely uncommon.
If a tear of the proximal biceps tendon occurs there is a risk that the rotator cuff tendons are possibly damaged as well.
A distal biceps tendon tear happens to the single tendon – the “distal tendon” that connects the biceps to the elbow; these types of tears are relatively common, typically are caused by an injury or trying to lift an overly heavy object and occur in people generally over the age of 40 years.
Distal biceps tendon tears tend to be complete tears where the muscle and tendon is fully separated from the bone.
What causes a bicep tear?
Both types of biceps tears can happen when the shoulder or elbow joints (or both) are twisted in an awkward and unnatural way, or if you fall down with your arm outstretched, trying to catch yourself or break the fall.
Lifting heavy objects or moving large pieces of furniture is often the cause of biceps tears at the elbow as well.
Some of the risk factors for bicep tears or biceps tendon ruptures include age, being a smoker, shoulder overuse through sports (baseball, tennis, AFL) or workplace activities (construction, carpentry) that require repetitive overhead or overhand shoulder motion, regular heavy overhead lifting activities (weightlifting or highly physical jobs), and regular use of corticosteroid medications.
What are the signs and symptoms of a bicep tear?
If you experience sudden, severe pain in the upper region of your arm or shoulder, or near the elbow, then you may have a bicep tendon tear and you may or not hear or feel a popping sensation when you tear a tendon.
You may also experience sharp pain in your shoulder or elbow and a feeling of weakness at those joints, and pain may radiate down anteriorly to the muscle belly.
Other symptoms of a torn bicep include bruising on your upper arm or forearm. There may also be a shift in the shape or contour of the bicep muscle at the front of your arm.
This is known as a “Popeye” deformity due to the bunching up of the muscle in the lower part of the upper arm.
Lastly, you may also have difficult turning rotating your arm into different positions; e.g. from a palm up to palm position.
Partial bicep tear vs complete biceps tears
A partial bicep tear occurs when the tendon isn’t fully detached from the bone, and will more than likely be the aforementioned proximal biceps tear or shoulder biceps tear as opposed to a distal biceps tear.
They can be more complicated to diagnose since these contours of the muscle usually do not change or “pop” like they do in a completely ruptured bicep, and may occur from a strain over time as opposed to an acute injury.
On the other hand, a complete biceps tear is when the tendon completely detaches from the bone and the muscle retracts; these are more common at the elbow joint but they can occur at the shoulder as well.
How is a bicep tear diagnosed?
Imaging tests like X-rays and magnetic resonance imaging (MRIs) along with a battery of physical tests are used to diagnose biceps tears and rule out other shoulder injuries or issues.
The problem is usually fairly apparent with complete ruptures because of the “Popeye” appearance of the bicep muscle; however partial tears may be less obvious and your surgeon will ask you to move and rotate your arm in a variety of ways to determine the source of your pain and if you have a partially torn bicep or another similar issue.
What shoulder and arm issues are similar to bicep tears?
Bicep tendonitis can feel similar to a bicep tendon rupture or a torn bicep, and partial tears are often treated in a similar fashion.
Bicep tendonitis is an inflammation of the long head tendon or the main tendon that attaches the top of the biceps muscle to the shoulder.
It’s often caused by overuse or excessive strain from repetitive overhead lifting or overhand throwing motions common in certain sports.
Your doctor will use the aforementioned diagnostic tests to determine exactly what your issue is and then work with you on a treatment plan for it.
Non-surgical treatments for biceps tears
Surgery may be needed to repair a torn bicep tendon, particularly if it is a complete tear and the pain is affecting your ability to perform everyday tasks.
However, in some cases people with torn tendons can still function normally with physiotherapy and close monitoring by an orthopaedic surgeon.
You should be aware that partial shoulder biceps tears are more likely to respond to nonsurgical options, while full thickness biceps tears at either the shoulder or elbow joint are more likely to require surgical intervention.
Ice packs, non-steroidal or anti-inflammatory medication, and resting the affected arm will also be recommended.
Surgical treatments for biceps tears
If you have suffered a torn bicep and it’s not responding to nonsurgical treatment, then surgery is the next choice, especially if you are still in significant pain, suffering from weakness at the shoulder or elbow joint, or if the shape and contour of your bicep muscle is still raised or appears to be a “Popeye muscle”.
Surgery for a torn bicep can often help you regain nearly all of your normal arm strength and function.
Note that if you do choose to have surgery on an elbow or shoulder biceps tear, you’ll need to work with a physiotherapist on your arm’s flexibility and strength for at least several months post-surgery.
Biceps tear surgery recovery time
You will likely need to spend some time with your affected arm in a sling and will want to plan ahead prior to your surgery for some immobility.
If you can, set up things up in advance (e.g. placing commonly used items in places where you can reach without used the impaired arm), make some meals ahead of time, and ideally have a friend or family member around to help you in the immediate aftermath.
The immediate post-surgery days will be fairly similar to any other type of surgery, with antibiotics and painkillers being prescribed.
You should be able to go home fairly quickly or perhaps even the same day as your surgery, but will need a fair amount of help as previously described, since you won’t be able to use your affected shoulder.
Your arm will be in a sling when you leave the hospital and probably for some time afterwards, but you should be fairly independent not too long after a successful biceps tendon repair surgery.
Rehabbing a bicep tear
Physiotherapy is always recommended for any type of biceps tear or biceps tendonitis, with the goal of strengthening the arm and restoring its functionality and flexibility.
This may be required for a few months or longer, depending on the severity of the tear, your arm’s condition prior to the tear, and a number of other factors. Your orthopaedic surgeon will work with you on a treatment plan.
How to prevent a bicep tear
There are a number of preventative measures that you can take to avoid experiencing a rupture or tear in your bicep tendons, including working out to maintain strength and flexibility in your shoulders, elbows, and forearms, especially as you get older.
Some physical activities should also be avoided as you age since the tendons weaken and are more likely to fray in older individuals.
Repetitive overhead lifting, overhand throwing, extremely forceful pushing or pulling activities like rowing, or simply lifting heavy objects (weightlifting or even simple household tasks). You should also use special care when lowering heavy objects to the ground.
And of course, being a nonsmoker and not using steroids will help prevent bicep tears along with a number of other health conditions.
If you think you may have torn or ruptured your bicep or have any other pain or issues in your joints, the next step should be to contact your orthopaedic surgeon to diagnose the problem and determine the proper course of treatment.