Biceps Ruptures and Surgery
Overview
The biceps is a muscle within the front of the upper arm. It has two tendinous attachments in the shoulder (the long and short heads) and one combined attachment site in the elbow. Within the shoulder, the long head of the biceps tendon is most commonly disordered. The long head has a variable attachment site deep within the shoulder joint itself onto the superior labrum and the upper part of the shoulder socket. It runs in a groove (the biceps groove) along the front of the humeral head between the rotator cuff tendons. The biceps functions as the main supinator of the forearm; powering the ability to twist one’s palm upwards. It has a secondary role in bending the elbow.
Causes
Biceps issues can occur both from wear and tear and traumatic causes. It is also common to experience tendinosis of the tendons. Tear of the biceps tendon occur both within the shoulder (long head of biceps ruptures) and within the elbow (distal biceps tendon rupture). Tears in the shoulder are oftentimes associated with rotator cuff tears. Distal ruptures commonly occur from a dramatic overload to the arm. We oftentimes also see partial tears of the biceps tendon related to wear and tear. While technically a labral tear, superior labral tears (SLAP tears) violate the attachment site of the biceps.
Symptoms
Patients with a biceps issue can notice discomfort in the front of the shoulder that runs into the biceps muscle belly. This can be associated with weakness and pain with overhead activities and with decreased biceps strength. When a complete rupture occurs, patients usually experience a painful ‘pop’ with bruising, swelling, and a ‘Popeye’ deformity.
Painful clicking with overhead activities can signal a superior labral tear (SLAP tear) where the biceps attaches.
Diagnosis
A thorough physical examination will assess your strength, range of motion, and certain provocative tests can help narrow down the source of your symptoms. X Rays will evaluate for any fractures, bone loss, or arthritis. An MRI is typically also necessary to evaluate for soft tissue tears and/or inflammation within the biceps.
Treatment
The type of biceps lesion will help determine the course of treatment.
Physical Therapy
Strengthening the dynamic stabilizers of the shoulder and improving the biomechanics of the shoulder girdle can be effective treatment for many types of shoulder dysfunction. This is particularly useful for superior (SLAP) labral tears and in overhead athletes. Physical therapy cannot heal a labral tear, but is aimed at improving the mechanics of shoulder function and can help alleviate pain and improve exercise tolerance. An appropriately structured rehabilitation program can also alleviate many forms of tendinitis pain.
Injections
Injections, including cortisone and PRP (platelet rich plasma), can also be utilized to lessen the pain from a biceps issue. They may be curative in cases of tendinitis.
SURGICAL MANAGEMENT
For those patients with persistent symptoms and patients who have completed and failed other conservative treatments, surgery may be indicated. Active patients who wish to maintain full strength of their arm will typically choose surgery for distal biceps ruptures.
Biceps Tenodesis. Damage to the proximal (upper) portion of the biceps tendon is addressed by reattaching the tendon to the humerus bone. This preserves the length-tension relationship, preserving strength and limiting any Popeye deformities. Biceps tenodesis techniques include both arthroscopic and open variations depending on the extent and area of damage to the tendon. After surgery patients use a sling for comfort, start shoulder and elbow range of motion immediately and can start a strengthening program after 1 month. It can take up to 6 months to have a more full return to all activities.
Arthroscopic Superior Labral Repair (SLAP repair). Through a few small incisions, I repair the labrum and biceps back to the glenoid with a number of small anchors. A typical return to sporting activity takes between 3-5 months depending on the sport. SLAP repairs are indicated in younger individuals (typically younger than 30 years).
Distal Biceps Tendon Repair. I repair ruptures of the distal biceps tendon through a small one-inch incision over the elbow. The torn end of the tendon is retrieved and reattached to the anatomic insertion site on the radius bone with a special anchor button. Ideally, we like to repair these ruptures within 6 weeks of the injury to ensure the tendon can still be stretched back to the insertion site. Most patients do not require any bracing after surgery. A graduated strengthening program starts at 6 weeks, with most patients back to sporting activities by 4 months.
Biceps Surgery in Oregon
Dr. Daniel Elkin is a leading Orthopedic Surgeon performing Shoulder and Elbow Surgery in the Willamette Valley. He specializes in complex shoulder and elbow repairs and shoulder arthroscopy and is conveniently located in Salem, Oregon