Biceps Tendon Injuries

Anatomy of the Shoulder

The biceps muscle is located at the front of your arm. Muscles are attached to bone by fibrous connective tissue called tendons. A tendon allows us to move our limbs by working as levers to move bones as the muscle contracts. The biceps muscle has two proximal tendons (long head and short head) that attach to the shoulder and a distal tendon that attaches the muscle to the radius bone (forearm bone) at the elbow.

The two tendons of the upper biceps tendon at the shoulder joint are called the proximal biceps tendons. The long head attaches to the top of the shoulder socket (glenoid). The short head attaches to the hook-shaped bone on the shoulder blade (coracoid process). The long head of the biceps tendon is most likely to be injured. Fortunately, the short head of the biceps rarely tears and because of this second attachment, most people can still use their biceps even after a complete tear of the long head.

Injuries to the biceps tendons include:

• Proximal (shoulder) biceps tendonitis
• Proximal (shoulder) biceps tendon tear
• Distal (elbow) biceps tendonitis
• Distal (elbow) biceps tendonitis tear

Biceps Tendon Tear at the Shoulder

Biceps tendon tears can be either partial or complete and can be the result of injury or overuse. Lifting heavy objects or falling on an outstretched arm are common ways to injure the biceps tendon. Overuse injuries are the result of the tendon fraying over time and can occur naturally with age or be the result of a repetitive movements that wear the tendon down. Other shoulder problems like shoulder impingement, rotator cuff problems, and shoulder instability issues also put stress on the biceps tendon making it more likely to weaken or tear.

A person who tears their biceps tendon may experience a sudden, sharp pain at the site of the injury. They may also hear an audible “pop” or snap when the injury occurs.

Other symptoms include:

• Bruising from the middle of the upper arm down toward the elbow
• A feeling of weakness in the shoulder or elbow
• Pain or tenderness at the shoulder and the elbow
• Trouble rotating the arm from a palm down to a palm up position
• A bulge in the upper arm above the elbow (“Popeye muscle”)

What are Distal Biceps Tears?

Lifting a heavy object such as a large appliance or piece of furniture can tear the lower biceps tendon (distal biceps tendon tear). Tears of the distal biceps tendon are unusual, however, this type of injury usually involves a complete tear. The muscle separates from the bone and retracts, causing weakness in the arm. A person will be unable to forcefully turn their arm from palm down to palm up (imagine tightening a screwdriver).

Treatment of Proximal Bicep Tears

Nonsurgical Treatment

For most people, pain from a long head biceps tendon tear resolves over time. Mild arm weakness or arm deformity do not typically bother most patients. In addition, if other shoulder structures such as the rotator cuff muscles are intact, this is a reasonable option.

Surgical Treatment

You may benefit from surgery to repair the torn tendon if your symptoms cannot be relieved by nonsurgical treatments and you develop cramping in the muscle or pain. Athletes and manual laborers may also require surgery for a complete recovery of strength.

The goal of surgery is to re-anchor the torn tendon back to the bone. Immobilization in a sling is usually required for a period of time followed by range of motion and strengthening exercises prescribed by Dr. Harrison.

What is Biceps Tendonitis?

Biceps tendinitis is an inflammation of the upper biceps tendon. Distal biceps tendonitis is an inflammation of the tendon area that connects the biceps muscle to the radius bone at the elbow.

Tendons are remarkably strong and have one of the highest tensile strengths found among soft tissues. Their strength is necessary to withstand the stresses generated by muscle contraction. However, overuse during sports or due to occupational needs can cause painful inflammation. This is caused by micro tears in the tendon, which is known as tendonitis.

You can have inflammation of the upper biceps tendon (proximal biceps tendonitis) or lower biceps tendon (distal biceps tendonitis), although it is unusual to have tendonitis in both the shoulder and the elbow at the same time.

Non-surgical treatment options such as RICE treatment (rest, ice, compression, elevation), wearing a brace, and adding a physical therapy program can alleviate inflammation, pain and discomfort. Surgical treatment may be necessary for more advanced biceps tendonitis injuries.

Proximal Biceps Tendonitis

Inflammation of the upper biceps tendon often causes pain in the front of the shoulder. It can happen on its own or in conjunction with a shoulder injury. Often, this involves damage to the rotator cuff tendons.

Symptoms might include:

• Pain or tenderness in the front of the shoulder, which worsens at night
• Pain lifting, pulling or reaching overhead
• Pain or achiness that moves down the upper arm bone
• Stiffness or weakness in the shoulder
• An occasional snapping sound or sensation in the shoulder

Distal Biceps Tendonitis

Symptoms of distal biceps tendonitis are usually most noticeably where the bone and tendon meet near the elbow.

Symptoms might include:

• Pain when moving the elbow joint
• Mild inflammation or swelling
• Tenderness in the limb or joint
• Pain in the spot inside your elbow

Bicep injuries are common and usually accompany other shoulder issues. Dr. Harrison will perform an exam on your upper extremity including your arm and shoulder. X-rays and MRI scans are also ordered to aid in the treatment plan. If you are experiencing pain in your arm or shoulder, contact Dr. Harrison for a consultation.

Dr. Harrison is a board-certified fellowship trained orthopedic and sports medicine surgeon who specializes in arthroscopic knee and shoulder surgery. He is the Head Team Physician for the United States Alpine Ski Team and the Head Team Physician for Weber State University for over 20 years. Dr. Harrison completed his undergraduate degree at Baylor University and received his medical degree from the University of Arizona College of Medicine. He completed his orthopedic residency at the University of Utah followed by a fellowship in sports medicine at the Cincinnati Sports Medicine and Orthopedic Center. He finished his formal training with an additional AO Trauma Fellowship in Bern, Switzerland.

Schedule a shoulder consultation

If you have symptoms consistent with a biceps tendon injury, call our office or book an appointment with shoulder surgeon Dr. Jeffrey Harrison. Dr. Harrison specializes in diagnosing and treating of biceps tendon injuries. Dr. Harrison regularly sees patients from throughout Utah including Ogden, Salt Lake City, Park City, Logan, and other communities.