Two different damage
A tear of the long head of the biceps at the shoulder joint is the most common injury to the biceps. The tendon runs through the shoulder joint in a narrow groove, wears for decades, and at some point breaks, sometimes during normal movement. The muscle slides down, but the second head and brachialis continue to bend the arm, so the loss of strength is small. A tear of the distal tendon at the elbow is another matter: this is the only place of attachment of the muscle to the forearm, and when it is torn, the upward rotation of the palm is noticeably weakened. Such a rupture usually occurs simultaneously with a powerful load on the bent arm.
- Rupture of the long head at the shoulder - more common in people over 50 years of age
- Usually due to long-standing wear and tear of the tendon
- Severance of the distal tendon at the elbow - more common in men 40–60 years old
- Mechanism - sudden lifting of weight with a bent elbow
- Partial tears with pain without deformation
- Short head rupture is very rare
Symptoms
When a tear occurs at the top, a person often hears or feels a click and feels a sharp pain in the front of the shoulder, which then quickly decreases. After a day or two, a bruise appears, and the muscle moves downward, forming a convex ridge above the elbow. When a tear occurs below, pain occurs in the elbow bend, a dip is felt there, the muscle is pulled up, and the bruise spreads along the forearm. The key symptom is weakness when turning the forearm with the palm facing up, especially noticeable when trying to turn a key or screwdriver.
- Clicking and sharp pain at the time of injury
- Muscle deformation: roll at the bottom or dip at the elbow
- Bruising on the shoulder or forearm
- Weakness of elbow flexion
- Marked weakness of outward rotation of the forearm
- Pain on exertion, decreasing after a few days
Diagnostics
The diagnosis is often obvious upon examination: altered muscle contour, dip or roll, weakened rotation of the forearm. For distal avulsion, a test with muscle compression is used: with a complete rupture, the forearm does not rotate. Ultrasound is a quick and accessible method that clearly shows the tendon and the degree of its displacement. MRI more accurately determines complete or partial rupture and helps plan surgery, especially in unclear cases and in obese patients. X-rays are taken to rule out bone damage and avulsion of a bone fragment.
- Examination assessing muscle contour and forearm rotation strength
- Biceps compression test
- Ultrasound of tendons and soft tissues
- MRI of the shoulder or elbow joint
- X-ray to rule out bone avulsion
- Comparison with a healthy hand
Treatment
A rupture of the long head at the shoulder in older people and with low strength requirements is often treated without surgery: rest for several days, pain relief, then gradual restoration of movements and strengthening of the muscles. The cushion on the shoulder remains, but has little effect on function. The operation is discussed in young people, athletes and those who are concerned about cosmetic defects or muscle spasms. On the contrary, avulsion of the distal tendon at the elbow almost always requires surgical refixation to the radius, and it is better to perform this in the first two to three weeks: later the tendon shortens and scars, which complicates the operation.
- Rest, cold and pain relief in the first days
- Conservative management of long head rupture in the elderly
- Tenodesis or tenotomy if indicated at the shoulder
- Refixation of the distal tendon to the radius
- Early surgery for avulsion at the elbow
- Gradual strength recovery program
Recovery
After conservative treatment of a shoulder tear, movement is restored within a few weeks, and strength training is added gradually over two to three months. After surgery on the distal tendon, the arm is fixed with an orthosis, movements in the elbow are expanded in stages according to the surgeon’s scheme, heavy lifting is prohibited for about three months, and a full return to hard work and sports takes about six months. Violation of the regime is the main reason for repeated separation. Smoking slows down the healing of the tendon, so it is recommended to avoid it during the treatment period.
- Gradual expansion of movements in the elbow after surgery
- Orthosis for several weeks
- No heavy lifting for about 3 months
- Gradual strengthening of the shoulder and forearm muscles
- Return to hard work after about six months
- Quitting smoking during the healing period