Biceps tendon tears

Doctor, I was carrying a sheet of drywall with a friend, and it suddenly slipped from his hands. I caught it, but felt a sudden pop and tearing sensation in my elbow.

This is common story – a sudden force is applied to the elbow, a pop or tearing sensation occurs, and the elbow becomes painful. There is usually some asymmetry to the appearance of the biceps muscle and it can be painful to turn the palm upward.

What is the biceps?

Biceps AnatomyThe biceps is a muscle of the arm with two parts (‘bi’). These muscle ends attach at the top in the shoulder joint and on the shoulder just below the collar bone. They come together at the far end near the elbow to form the biceps tendon and attach on the radius bone of the forearm. The way it attaches causes contraction of the muscle to rotate the palm upward, for example, like turning a screwdriver.

How is a biceps tear diagnosed ?

The diagnosis is made by the history and exam. The story is always one of a specific injury with subsequent pain, limited motion, and weakness on supination of the forearm. An MRI may help show the zone of injury, but can be difficult to determine if the tear is partial or complete.

Do I need surgery for a biceps tear ?

The decision for surgery is made based on the needed level of elbow function. If you work a physical job, or want to remain active in sports or other physical activities, having it repaired will likely give a better long-term solution. While you can live with a torn biceps, it does lead to weakness and ‘fatiguability’ of the affected arm.

How is a biceps tear repaired surgically ?

The end of the tendon is attached in a repair. This is done by finding the torn end of the tendon, placing stitches in it, and then creating a place to plug it into the radius bone in just the right place. This procedure requires a general anesthetic and can be done through either one or two incisions. This is not an arthroscopic surgery. The risks of surgery include nerve injury, long term elbow stiffness, and potential bone formation limiting movement. While rare, it is always a good idea to discuss these things with me.

After surgery, your arm will be in a sling for a few weeks. We will start working on range of motion to keep your elbow from becoming stiff. I will et you start lifting weight around week 12. The whole process to full recovery will take many months.
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Dr. Scott Hacker is a Sports Medicine Orthopedic Surgeon in San Diego, CA, Team Surgeon to the US Olympic Team. He specializes in sports medicine and sports injuries, knee and shoulder surgery.

If you have questions about biceps tendon tears, or have a biceps tear, please feel free to contact me at Ask Dr. Hacker or through my office.

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