Biceps Tendon Tears at the Elbow: Overview

Biceps Tendon Tears at the Elbow: Overview

A biceps tendon tear at the elbow is damage to the tendon that connects the biceps muscle of the front upper arm to the large bone of the forearm, called the radius. The tear or rupture may occur suddenly or acutely when lifting a heavy object like large appliances or furniture, as part of a twisting elbow injury, falling onto an outstretched hand, or after constant overuse, also known as chronic overuse. This is where the tendon frays and eventually tears, either partially or completely off and away from the bone.

Biceps tendon injuries of the elbow occur mainly in the dominant arm, especially in males 30 to 60 years old. It is rare, affecting only 1.2 out of 100,000 patients per year with an average age of 47. For smokers, the risk of injury is 7.5 times higher. This type of injury is uncommon in women.

The mechanism of action of the tear may be from a very big force on a flexed or bent elbow where it is suddenly placed into a straight position. With enough weight, the tendon can tear from being stretched to its full capacity until it cannot stretch anymore. A twisting motion or rotation angle can also contribute to the failure at rupture.

Biceps tendon tears may be prevented by being aware of repetitive movements. Warming up and stretching before involving the use of the arms is advised. Proper technique while exercising can avoid excessive stress on tendons. Consult the doctor or physical therapist about any concerns with movements to help reduce wear on the tendon.

Let us look at some quick anatomy to further understand the injury. The elbow joint is made up of 3 bones: the radius, ulna, and humerus. Let us focus attention on the radius and its radial tuberosity. This tuberosity is a protruding bump where the biceps tendon attaches. This tendon is a very tough strip of tissue that connects the biceps muscle to the radius and allows for movement of the upper arm.

This large tendon actually has 2 smaller parts or heads that make up the end part of the biceps muscle. Either one or both of these heads may tear partially or completely off the bone.

Patients commonly report a history of a sudden tearing sensation or a traumatic pop while stressing the elbow in a flex position, severe bruising or ecchymosis, as well as pain at the front of the elbow. The pain subsides after the acute sudden injury. If left untreated, a chronic rupture is usually not painful. When the tear is complete, the muscle usually retracts back up into the arm. This is called a reverse Popeye deformity. A delay in diagnosis may lead to weakness over time.

One test the doctor may perform is called the hook test. The doctor bends the arm slightly and hooks his or her finger under the biceps tendon to see if the tendon is still attached. The tendon feels like a tight cord or rope when it is attached. If there is still doubt, further imaging techniques can help with diagnosis.

Plain radiographs or x-rays are usually normal in this injury, however, as they can best see bony tissue but not soft tendons or muscular tissue. An MRI gives much more information about this type of injury because it can see soft tissues it can distinguish between partial and complete tears and assess retraction of the tendon. Once the diagnosis is certain, the doctor will outline the treatment plan to the patient.