Biceps Tenodesis

The biceps muscle is present on the front side of your upper arm and functions to help you bend and rotate your arm. The biceps tendon is a tough band of connective fibrous tissue that attaches your biceps muscle to the bones in your shoulder on one side and the elbow on the other side.

Overuse and injury leads to fraying of the biceps tendon and eventual rupture. A biceps tendon rupture can either be partial, where it does not completely tear the tendon, or complete, where the biceps tendon completely splits in two and is torn away from the bone. The Biceps tendon can tear at the shoulder joint or elbow joint.

The majority of biceps tendon ruptures occur at the shoulder and is referred to as proximal biceps tendon rupture. When it occurs at the elbow it is referred to as a distal biceps tendon rupture, however this is much less common.

Causes & anatomy

Biceps tendon ruptures occur most commonly from an injury, such as a fall on an outstretched arm, or from overuse of the muscle, either due to age or from repetitive overhead movements such as with tennis and swimming.

Biceps tendon ruptures are common in people over 60 who have developed chronic micro tears from degenerative changes and overuse. These micro tears weaken the tendon making it more susceptible to rupturing.

Other causes can include frequent lifting of heavy objects while at work, weightlifting, long term use of corticosteroid medications and smoking.

Symptoms

The most common symptoms of a biceps tendon rupture include:

• Sudden, sharp pain in the upper arm
• Audible popping sound at the time of injury
• Pain, tenderness and weakness at the shoulder or elbow
• Trouble turning the arm palm up or down
• Bulge above the elbow (popeye sign)
• Bruising to the upper arm

Nonsurgical treatment

For older patients most proximal biceps ruptures can be treated conservatively with the following:

• Rest: A sling is used to rest the shoulder and you are advised to avoid overhead activities and heavy lifting until healed.
• Ice: Applying ice packs for 20 minutes at a time, 3 to 4 times a day, helps reduce swelling.
• Medications: Non-steroidal anti-inflammatory medicines help reduce pain and swelling.
• Physical therapy: Strengthening and flexibility exercises help restore strength and mobility to the shoulder joint.

Surgical treatment

For proximal ruptures or tears treatment varies based on the particular case.

Partial tears are treated arthroscopically.

An acute rupture may be fixed for people who do a lot of repetitive lifting since this can cause cramping if left untreated. This requires a mini-open incision to retrieve the retracted tendon and fix it into the bone.

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