Biceps tendon rupture

A biceps tendon rupture is a complete or partial rupture of a tendon of the biceps brachii muscle. It can affect the distal tendon, or either/both of the proximal tendons, attached to the long and short head of the muscle, respectively.

Not to be confused with Biceps femoris tendon rupture.
Distal biceps tendon rupture, with proximal retraction of the muscle.
Panoramic ultrasonography of a proximal biceps tendon rupture. Top image shows the contralateral normal side, and lower image shows a retracted muscle, with a hematoma filling out the proximal space.

Signs and symptoms

When a biceps tendon ruptures, the muscle belly changes position in the arm.[1] The bulge that forms is often known as Popeye's sign, due to the similarity in appearance to the cartoon character Popeye.[1]

Causes

A biceps tendon rupture may occur during athletic activities, however avulsion injuries of the distal biceps tendon are frequently occupational in nature and sustained during forceful, eccentric contraction of the biceps muscle while lifting.[2]

Treatment

Acute rupture of the distal biceps tendon can be treated nonoperatively with acceptable results,[3] but because the injury can lead to 30% loss of elbow flexion strength and 30-50% loss of forearm supination strength, surgical repair is generally recommended.[4][5][6] Complete distal biceps tears are commonly treated with re-attachment of the biceps tendon to its native insertion on the tuberosity of the radius using bone tunnels, suture buttons, or suture anchors.[7][4][8] Proximal ruptures of the long head of the biceps tendon can be surgically addressed by two different techniques. Biceps tenodesis includes release of the long head of the biceps tendon off of its insertion on the glenoid and re-attachment by screw or suture anchor fixation to the humerus. Biceps tenotomy consists of simple release of the long head of the biceps without reattachment to the humerus, allowing the tendon to retract into the soft tissues of the proximal upper arm.[2] Degeneration of the tendon can cause partial tears and are rarely associated with a traumatic event.

Treatment of a biceps tear depends on the severity of the injury. In most cases, the muscle will heal over time with no corrective surgery. Applying cold pressure and using anti-inflammatory medications will ease pain and reduce swelling. More severe injuries require surgery and post-op physical therapy to regain strength and functionality in the muscle. Corrective surgeries of this nature are typically reserved for elite athletes who rely on a complete recovery.[9]

References
  1. Yoshida, Naoki; Tsuchida, Yoshihiko (2017-11-16). ""Popeye" Sign". New England Journal of Medicine. 377 (20): 1976–1976. doi:10.1056/NEJMicm1704705. ISSN 0028-4793. PMID 29141167.
  2. Miller MD, Thompson SR, DeLee J, Drez D (2015). DeLee & Drez's orthopaedic sports medicine : principles and practice (Fourth ed.). Philadelphia, PA. ISBN 978-1-4557-4376-6. OCLC 880421005.
  3. Freeman CR, McCormick KR, Mahoney D, Baratz M, Lubahn JD (October 2009). "Nonoperative treatment of distal biceps tendon ruptures compared with a historical control group". The Journal of Bone and Joint Surgery. American Volume. 91 (10): 2329–34. doi:10.2106/jbjs.h.01150. PMID 19797566.
  4. Morrey BF, Askew LJ, An KN, Dobyns JH (March 1985). "Rupture of the distal tendon of the biceps brachii. A biomechanical study". The Journal of Bone and Joint Surgery. American Volume. 67 (3): 418–21. doi:10.2106/00004623-198567030-00011. PMID 3972866.
  5. Baker BE, Bierwagen D (March 1985). "Rupture of the distal tendon of the biceps brachii. Operative versus non-operative treatment". The Journal of Bone and Joint Surgery. American Volume. 67 (3): 414–7. doi:10.2106/00004623-198567030-00010. PMID 3972865.
  6. Nesterenko S, Domire ZJ, Morrey BF, Sanchez-Sotelo J (March 2010). "Elbow strength and endurance in patients with a ruptured distal biceps tendon". Journal of Shoulder and Elbow Surgery. 19 (2): 184–9. doi:10.1016/j.jse.2009.06.001. PMID 19664936.
  7. Sotereanos DG, Pierce TD, Varitimidis SE (May 2000). "A simplified method for repair of distal biceps tendon ruptures". Journal of Shoulder and Elbow Surgery. 9 (3): 227–33. doi:10.1067/mse.2000.105136. PMID 10888168.
  8. Bain GI, Prem H, Heptinstall RJ, Verhellen R, Paix D (March 2000). "Repair of distal biceps tendon rupture: a new technique using the Endobutton". Journal of Shoulder and Elbow Surgery. 9 (2): 120–6. doi:10.1067/2000.102581. PMID 10810691.
  9. "Bicep tear - Muscular Injuries". Sports Medicine Information.
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