A bicep tear is a common injury involving damage to the tendons connecting the bicep muscle to the bone. This leads to pain, swelling, and reduced arm strength. This article outlines both non-surgical and surgical approaches to address these tears.
Understanding a Bicep Tear
The biceps muscle, located on the front of the upper arm, plays a role in bending the elbow and rotating the forearm. It connects to bone via tendons: two at the shoulder (proximal tendons) and one at the elbow (distal tendon). The two proximal tendons include the long head, which attaches inside the shoulder joint, and the short head, which attaches to a bony bump on the shoulder blade. The distal biceps tendon attaches to the radius bone in the forearm, near the elbow.
Bicep tears typically result from sudden force, such as lifting a heavy object or falling on an outstretched arm. Overuse, which causes the tendons to fray and weaken over time, can also lead to a tear. Common symptoms include sudden, sharp pain in the upper arm, sometimes accompanied by an audible “pop” or “snap” sound. Swelling, bruising, and weakness in the affected arm are also frequently observed.
Tears can be categorized as partial, where the tendon is damaged but not completely severed, or complete, where the tendon fully detaches from its attachment point. Furthermore, tears are classified by their location: proximal tears occur at the shoulder, while distal tears happen at the elbow. Proximal tears, particularly in the long head of the biceps, are more common and often result from age-related degeneration or overuse. Distal tears, though less common, typically occur due to sudden, forceful events and can result in a significant decrease in arm strength if left untreated.
Non-Surgical Repair Options
Non-surgical management is often recommended for partial bicep tears or in older individuals with lower functional demands. This approach aims to reduce pain and inflammation while restoring arm function. Initial treatment involves rest, avoiding heavy lifting and overhead activities to allow healing. A sling may be used temporarily to immobilize and protect the arm.
Applying ice helps manage swelling and pain. Over-the-counter pain relievers, such as NSAIDs like ibuprofen or naproxen, also reduce discomfort and inflammation. Once initial pain and swelling subside, physical therapy becomes a central component. A physical therapist guides patients through exercises to restore flexibility, range of motion, and gradually strengthen surrounding muscles.
Surgical Repair Procedures
Surgical intervention is considered for bicep tears when non-surgical options are insufficient, especially for complete tears, in younger or more active individuals, or when full arm strength and function are desired. The specific surgical technique depends on the tear’s location. For proximal bicep tears at the shoulder, a common procedure is biceps tenodesis. This involves detaching the torn long head of the biceps tendon from its original attachment in the shoulder joint and reattaching it to the humerus, the upper arm bone, typically just below the shoulder. This reattachment helps alleviate pain and prevent the “Popeye” deformity, where the muscle bulges due to retraction.
Another option for proximal tears, less commonly performed for functional recovery but sometimes chosen for pain relief, is a tenotomy, where the tendon is simply cut. For distal bicep tears at the elbow, surgery almost always involves reattaching the torn tendon directly to the radius bone in the forearm. This reattachment is crucial for regaining full strength, particularly for forearm rotation (supination), which is significantly impacted by a distal tear. These surgical repairs often utilize sutures or anchors to secure the tendon firmly to the bone. Many of these procedures can be performed arthroscopically, using small incisions and a camera, which can lead to less invasive recovery.
Recovery After Repair
Recovery involves several phases to restore function. Immediately after surgical repair, the arm is immobilized in a sling or brace for several weeks, typically 4 to 6 weeks, to protect the healing tendon. Rest is encouraged during this initial period, and bicep-stressing activities are avoided.
Physical therapy begins a few weeks post-injury or post-surgery, focusing on gentle range-of-motion exercises to prevent stiffness. As healing progresses, strengthening exercises are gradually introduced, often with light resistance bands or weights. These exercises rebuild muscle strength and improve arm function. Rehabilitation is tailored to the individual, progressing through phases to restore flexibility, strength, and daily activities.
The overall recovery timeline varies based on the severity of the tear, the type of repair, and individual progress. For non-surgical cases, recovery can range from several weeks to a few months. After surgical repair, regaining full motion can take 4 to 6 weeks, while complete recovery and return to full activities might take 3 to 6 months or even longer, especially for heavy lifting or sports. Patients are often advised on safe lifting techniques and activity modifications to prevent re-injury.