Proximal Biceps Tendon Rupture

Proximal biceps tendon ruptures occur when the long head of the biceps tendon tears inside the shoulder. Long head of the biceps tendon functions as a humeral head depressor and is a secondary restraint to anterior instability, particularily in the abducted/internally rotated position. Proximal biceps tendon ruptures are associated with inflammatory arthritis, osteoarthritis, osteochondromatosis, bone spurs in the shoulder, rotator cuff pathology, and biceps instability.

Proximal Biceps tendon ruptures have been reported in softball players, weightlifters and baseball players. Although these injuries may initially have marked bruising in the shoulder and arm (see image to the left) with associated pain. This fairly rapidly resolves.

Proximal biceps tendon ruptures generally do not lead to long term functional limitations and professional athletes generally return to play with no limitations without any treatment. Nonsurgical treatment does lead to a 21% deficit in suppination strength, and an 8% deficit in elbow flexion strength, but no weakness in grip, pronation, or elbow extension strenght and infrequent pain. In the majority of people a painless deformity of the arm with the biceps muscle belly retracted distally into a ball develops ("Popeye" muscle seen in images on the left). This is less noticeable in larger people and more noticeable in thinnner people.

Treatment options include non-operative and operative treatments. Non-operatively treatment is aimed at controlling any initial pain with ice and pain medications. Patients may gradually resume activities as tolerated. Non-operatively treated patients gradually improve over 2-3 months with limited if any functional or strengths deficients. Cosmetic deformity with the biceps muscle belly rolled up into distal arm may develop, but is generally asymptomatic.

Surgical treatment is generally reserved for young physically active patients or patients involved in heavy labor occupations such as carpenters. Surgical treatment is a Biceps tenodesis. During a biceps tenodesis the long head of the biceps tendon is secured outside the shoulder joint at the top of the arm. Biceps tenodesis patients are protected with a posterior splint or sling for 2 weeks after surgery with immediate passive elbow and shoulder motion. Muscle strengthening is started at 6 weeks with return to sporting activites at 3-6 months. Potential complications of biceps tenodesis include but are not limited to: incomplete relief of pain, CRPS, cosmetic deformity, weakness, infection, DVT/PE, nerve or vascular injury and the risk of anesthesia including heart attack, stroke and death. Complications are uncommon and the most patients are satisfied with the results of surgery.

Further information about Proximal Biceps tendon ruptures can be found at the following sites:

Every person and their particular circumstances are different so the treatment for your shoulder may be different than those discussed. Please read this information carefully. Write down any questions that you have about your shoulder and its treatment and discuss them with your orthopaedic surgeon.

Synonyms: 
long head of biceps tendon rupture, tear

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