RUPTURE OF THE LONG BICEPS TENDON
Rupture of the long head of the biceps tendon
The long head of the biceps tendon runs from the glenoid through the shoulder joint towards the upper arm. A rupture of the long head of the biceps tendon (also called a biceps tendon rupture) is a common injury in which this tendon tears completely or in part. It mostly affects men over the age of 40, but also physically active people and patients with degenerative changes around the shoulder.
Causes and risk factors
Why does the long head of the biceps tendon tear?
The exact cause is not yet fully understood, but it is thought that a reduced blood supply to the tendon, degenerative processes and metabolic changes all play a part.
- Wear as part of chronic tendon damage (degeneration)
- Sudden load, for example when lifting heavy objects
- An accompanying injury with shoulder problems such as a rotator cuff tear or impingement syndrome
What makes a rupture of the long biceps tendon more likely?
A rupture of the long head of the biceps tendon frequently develops on structures that are already damaged. Various risk factors increase the likelihood of the tendon tearing – particularly under everyday or sporting load.
- Age over 40
- Overhead work or throwing sports
- Smoking
- Diabetes mellitus
Symptoms
A rupture of the long head of the biceps tendon often happens suddenly and unexpectedly – when lifting a heavy object, say, or with a jerking movement. In many cases the moment the tendon tears is clearly felt as a stabbing pain in the shoulder. But the injury is not always recognised as such straight away: after the initial pain it often subsides quickly, so that the seriousness of the situation is underestimated.
There are, however, typical signs that point to a torn tendon. These should always be assessed by a doctor – particularly if you notice a definite loss of strength, a visible change in the muscle or restricted movement.
Pain
Sudden, stabbing pain at the front of the shoulder, frequently together with a snapping sound or a feeling of something tearing – usually under load or with sudden tension
Marked change in the shape of the muscle
The belly of the biceps muscle retracts towards the elbow and bulges visibly – this is known as the "Popeye sign"
Bruising
Bruising (a haematoma) around the upper arm, sometimes also at the front of the shoulder
Treatment options
Treatment of a rupture of the long head of the biceps tendon depends on the extent of the symptoms, on age, on the physical demands the patient places on the arm and on the individual loss of function. One point is worth knowing: a rupture of this kind is not dangerous, but left untreated it can lead to lasting loss of strength, restricted movement or a change in the shape of the muscle that patients find cosmetically troubling.
A distinction is drawn between non-surgical and surgical treatment. Which method makes sense in an individual case is decided together with the patient after a thorough assessment.
Treatment options
Non-surgical and surgical – we will find the right approach for you
Rest and relief of load in the early phase
In the first days and weeks after the tendon tears, the affected arm should be loaded as little as possible. During this time avoid in particular heavy lifting or carrying, jerking movements of the arm, and overhead or pulling work of the kind involved in gardening or DIY. Resting the arm temporarily in a sling can help in the acute phase to relieve pain and take load off the tendon. It is important, however, that the arm is not immobilised for too long, as the risk of the shoulder stiffening then increases markedly.
Pain relief and anti-inflammatory treatment
At the start of treatment, medication is frequently used to relieve pain and inflammation. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac can help to relieve pain and reduce inflammation.
Physiotherapy
Targeted physiotherapy has a central role. The first aim is to maintain the range of movement of the arm and to prevent the muscle wasting. After the acute phase the treatment is intensified in order to strengthen the muscles and regain movement.
Arthroscopic reconstruction of the long biceps tendon
This is a minimally invasive method in which the tendon is fixed back in place through small incisions in the skin with the aid of a camera (an arthroscope). Its advantage is a shorter healing time and less pain.
Open surgery
In rarer cases an open operation may be necessary, in which the tendon is fixed directly to the bone of the upper arm.
Frequently asked questions about a rupture of the long biceps tendon
Here you will find answers to the questions most often asked about a rupture of the long head of the biceps tendon and its treatment.
How can you tell that the biceps tendon has torn?
Is a rupture of the long biceps tendon dangerous?
Does a biceps tendon rupture always need surgery?
Can I carry on training or working with a torn biceps tendon?
How is the diagnosis made?
What happens if the rupture is not treated?
What does the scar look like after an operation?
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