Biceps Tendon
A biceps tendon is a tough band of connective tissue which attaches the muscles to the bones. Injury or overuse by frequent lifting of heavy objects and weightlifting can result in weakness and consequently rupture of the tendon.
There is evidence to suggest that smoking and the use of steroids can also contribute to weakness on the tendon. Simple wear and tear as we age can also contribute to bicep tendon tears.
Ruptures of the tendon can be partial or complete, where the tendon is torn away at either the elbow (less common) or the shoulder.
Symptoms
Bruising on upper arm
Sudden onset of sharp pain in upper arm
Pain, tenderness and weakness
Visible or palpable bulge above elbow
Difficulty in moving arm up or down
Diagnosis
Physical Exam
Xray to assess deformities of the bone
MRI – to assess extent of tear
Treatment
Conservative
Rest
Pain control
Physiotherapy
Steroid injections – to educe pain and inflammation around the torn tendon
Surgical
Surgical treatment may be necessary if conservative measures have failed. Your surgeon will discuss with you on the best option for you which can either be a biceps tenotomy, debridement or a biceps tenodesis.
Surgical debridement - involves trimming the frayed edges of the tendon if it is partially ruptured in order to preserve the anatomy and structure of the tendon.
During a biceps tenotomy, the surgeon will detach the biceps tendon from its proximal attachment and allows it to retract down the arm. The tendon is not reattached.
Biceps Tenodesis
A biceps tenodesis is a procedure performed to treat injuries to the biceps tendon.
A small incision is made at the site of the rupture.
The surgeon will clean the tendon and the bone is prepared by drilling into the bone.
Sutures are then inserted into the tendon to tie it back to the bone.
Risks
Infection
Nerve Damage
Re-rupture
Pain
Bleeding
Rehabilitation following Biceps Tenodesis
Immediate Post operative Recovery
Usually discharged on the same day.
Use a sling to minimise activity of the bicep.
You will be shown how to put your sling on and off.
Stitches on the skin to come out at 10 – 14 days. Keep the wound site dry until the wounds have healed.
It is important to follow operation details and post operative instructions from your surgeon.
Take your painkillers regularly and use ICE to assist with pain and swelling.
Maintain good under-arm hygiene while in the sling.
Some important milestones
Return to light computer or desk work at around 4 weeks
Sling on for six weeks
Driving around 5 - 6 weeks
Swimming 3 weeks for breaststroke after weaning off sling
Front crawl - 6 weeks
Contact sport and manual work minimum 6 weeks depending on recovery
References
Kruger, N. et al (2020) Acute distal biceps tendon ruptures: anatomy, pathology and management - state of the art. Journal of ISAKOS. Vol 5(5)
Shoulderdoc (2022) Bones & Joints of the Shoulder. Accessed 18 September 2022 - https://www.shoulderdoc.co.uk/article/1177