Shoulder anatomy

The biceps tendon attaches the biceps muscle to bone at the shoulder and the elbow. At the shoulder the biceps tendon splits into two heads called the long and short heads. The biceps muscle allows bending at the elbow and rotating the forearm. Distal biceps tears are uncommon but can have a profound effect of function and activities that reply on the power to flex the elbow and rotate the forearm.

What is a distal biceps tear?

Injury to the long head is the most common type of biceps tendon injury and a common cause of shoulder pain and dysfunction.  Biceps tendon tears often occur with tears to the shoulder labrum and are also commonly associated with rotator cuff tears. Isolated biceps tendon tears are rare.

What are the symptoms of a distal biceps tendon tears?

Tears cause a loss of strength and pain especially when trying to turn the forearm palm up or down. Tears may be partial, where the tendon is not severed from the bone, and complete where the long head of the tendon is detached from the bone at the point of attachment most commonly at the shoulder. The short head of the tendon is usually not torn so most people with a distal tendon tear can still function even when the long head is completely severed.

Symptoms include:

• a sharp pain and weakness in the upper arm
• an audible pop or snap
• muscle spasms
• bruising
• pain and tenderness at the elbow or shoulder
• a bulge or deformity in the upper arm often called a Popeye arm

What causes a biceps tendon tear?

The two common causes are injury and overuse. Trauma can tear the tendon when you fall on an outstretched arm or try to lift something very heavy. Overuse causes the tendon to fray with wear and tear and repetitive motions. These tears are more common in dominant arm of men ages 30-60 often due to chronic overuse. Tears in younger men are usually due to trauma like an auto accident or a fall on an outstretched arm.

What are that risk factors for a tendon tear?

• age and normal wear and tear
• repetitive motions over time due to overuse
• corticosteroid injections and anabolic steroid use
• smoking increases risk 7.5 fold
• heavy lifting

How is a biceps tendon tear diagnosed?

Your orthopedic surgeon will review your medical history and ask about your symptoms and the cause of your pain and discomfort. They will conduct an orthopedic evaluation testing range of motion and strength; and order imaging studies including x-rays and an MRI.

How is a biceps tendon tear treated?

Most people can successfully recovery from the pain and dysfunction of a distal biceps tear with conservative, nonsurgical management including rest, activity modification, icing, over the counter anti-inflammatory medications and physical therapy. However, athletes and people who perform manual labor may need surgery to repair the tendon.

Safe and effective rehabilitation is essential to fully recover from a biceps tear without surgery, and after surgery. The goal is to restore range of motion and flexibility to optimize function and the ability to return to work and recreational activities.  A progressive rehabilitation program involves a sequence of phases from acute recovery to return to preferred activities. Each phase is tailored to the patient’s needs and restrictions.

Bracing is necessary to protect the soft tissues during healing and recovery after surgery. Therapeutic exercises are designed to gently exercise the shoulder, elbow, forearm, hand and wrist to begin to restore range of motion. As pain and swelling resolve, gentle strengthening exercises will be added. Your CAO Sports Performance Center your physical therapist will teach you how to protect your shoulder from injury including how to lift safely and exercises that can restore your ability to safely perform the activities of daily life and sports.

Did you know that you can access physical therapy without a doctor’s referral in California?

Contact CAO Sports Performance to schedule an appointment today to get the help you need to live your best life safely and effectively.