The biceps muscle is located on the front of the upper arm. Two separate tendons connect the muscle to the shoulder. A biceps rupture at the shoulder involves a tear of the main tendon that attaches the top of the biceps muscle to the shoulder. It happens most often in middle-aged people and is usually due to years of wear and tear on the shoulder. When a torn or ruptured biceps tendon occurs in a younger person, it is usually due to a sudden load on the arm such as may occur when weightlifting.
Muscles are composed of specialized tissues that are capable of contracting in order to produce body movements.
Tendons are tough bands of fibrous tissue that connect muscles to bones.
The biceps muscle extends from the shoulder to the elbow on the front of the upper arm. Two separate tendons, the long head of the biceps and the short head of the biceps, connect the upper part of the biceps muscle to the shoulder. These two tendons are called the proximal biceps tendons, because they are located at the top of the arm.
The lower part of the biceps muscle connects to the elbow by the distal biceps tendon.
The biceps muscle can:
- Bend the elbow upward.
- Flex the shoulder, lifting the arm up (a movement called flexion).
- Rotate or twist the forearm in a way that points the palm of the hand up.
For more information about shoulder anatomy, click here.
When the biceps tendon tears or ruptures, one may experience the following symptoms in the anterior (front) portion of the shoulder:
- A sudden sharp pain during activity.
- An audible pop or a perceived snapping sensation may be felt.
- Recurrent pain while performing overhead or repetitive activities.
- Shoulder soreness that may worsen at night.
- Bruising, or a visible and palpable mass (bulge) may appear between the shoulder and elbow. The bulge is due to the torn tendon fibers pulling off the shoulder and slipping down into the upper arm, where they come to rest as a balled up mass.
- Weakness in the arm.
Diagnosis of a rupture of the biceps tendon is based on the symptoms present, the doctor's examination, X-rays, and imaging studies such as MRI (magnetic resonance imaging).
The two most common causes of a rupture (tear) of the biceps tendon are:
- Wear and tear of the fibers of the tendon. This injury is usually seen in people who are between 40 and 60 years old. Years of shoulder wear and tear begin to fray the biceps tendon. Eventually, the long head of the biceps weakens and becomes prone to tears or ruptures.
- When a rupture or tear occurs in a younger person, it is usually due to a sudden load being placed on the arm as occurs in weightlifting.
In most cases, treatment of a ruptured biceps tendon can be accomplished without surgery. This is especially true for older individuals who can tolerate loss of arm strength.
Not having surgery usually only results in a moderate loss of strength. The short head of the biceps is still attached and continues to supply strength to raise the arm up.
Flexion of the elbow may be affected, but supination (the motion of twisting the forearm such as when you use a screwdriver) is usually affected more. Not repairing a ruptured biceps reduces supination strength by about 20 percent.
Nonsurgical treatments may include:
- A sling to rest the shoulder.
- Ice to help ease pain.
- Anti-inflammatory medications to help ease pain and swelling and to help return people to activity sooner.
- Occupational therapy to learn how to rest your shoulder and how to do your activities without putting extra strain on the sore area.
- Physical therapy often helps to reduce pain. In addition, physical therapists often prescribe exercises that help to strengthen other muscles in the arm that help to do the work of a normal biceps muscle.
Surgery is usually reserved for patients who need arm strength, are concerned with cosmetics of the balled up biceps, or who have pain that won't go away.
People with shoulder pain have also found these products to be effective: