Bicep Tendon Tear at the Elbow

Anatomy of the Biceps Tendon

The biceps muscle, located in the front of the upper arm allows you to bend the elbow and rotate the arm. Biceps tendons attach the biceps muscle to the bones in the shoulder and in the elbow. The biceps tendon that attaches the muscle at the elbow is known as the distal biceps tendon.

What is a Bicep Tendon Tear?

A biceps tear can be complete or partial. Partial biceps tendon tears will not completely break the tendon while complete tendon tears will break the tendon into two parts. Tears of the distal biceps tendon are usually complete, and the muscle is separated from the bone. Tears of the distal biceps tendon most often result from a sudden injury or lifting a heavy object.

Causes of Bicep Tendon Tears

A biceps tendon tear can be caused by an injury where your elbow is forced against resistance or while lifting heavy objects. Other problems such as tendonitis are more likely to weaken or tear the biceps tendon. Additional risk factors such as advancing age, smoking and use of corticosteroids can also result in a tendon tear.

Symptoms of Bicep Tendon Tears

The most common symptom of a biceps tendon tear is sudden, severe pain at the elbow. At times, you may hear a pop. Other symptoms may include swelling, visible bruising, weakness in the elbow, and trouble twisting the forearm. A bulge in the upper region of your arm because the tendon is no longer holding the muscle in place properly, and a gap in the front of the elbow because of the absence of the tendon.

Diagnosis of Bicep Tendon Tears

A biceps tendon tear is usually diagnosed based on your symptoms, medical history, and a physical examination. During the physical examination, your doctor will look for a gap in the front of the elbow. Your doctor will diagnose a partial tear by asking you to bend your arm and tighten the biceps muscle. You may have pain if there is a partial tear. X-rays may be taken to rule out other conditions causing elbow pain. Using an MRI scan, your doctor can confirm if the tear is partial or complete.

Treatment Options for Bicep Tendon Tears

Non-surgical Treatment Options for Bicep Tendon Tears

Conservative treatment for a proximal biceps tendon tear includes:

• Ice application
• Limiting activity
• Non-steroidal anti-inflammatory medications to reduce the pain and swelling
• Flexibility and strengthening exercises to restore the mobility and strength of the surrounding muscles

Surgery for Bicep Tendon Tears

Surgery to reattach the torn tendon back to the bone is rarely needed. However, it may be the best option for patients with partial tears who continue to experience symptoms after non-surgical treatments or who want all their arm strength back, such as athletes or manual labourers.

Your surgeon may opt for several surgical procedures for distal bicep tendon tear where the distal biceps tendon is reattached to the forearm bone. One or two incisions may be used. During the procedure, the tendon is attached with stitches through holes drilled inside the bone or small metal implants may be used to attach the tendon to the bone.

Post-surgical Care for Bicep Tendon Tears 

Following surgical repair, you will be advised flexibility and strengthening exercises to improve the range of motion in your shoulder.

Risks and Complications of Bicep Tendon Tears 

Complications are rare and may include numbness and weakness in the forearm, formation of new bone, limited movement and tearing may recur.