A bicep tear is an injury to the bicep muscle or its connecting tendons. This muscle, located at the front of the upper arm, extends from the shoulder to the elbow. It plays an important role in bending the elbow, rotating the forearm, and providing some stability to the shoulder joint.
Types of Bicep Tears
Bicep tears are categorized by their location and severity. Tears can occur either proximally, near the shoulder, or distally, near the elbow. Proximal tears, involving the two tendons connecting the bicep to the shoulder blade, are more common, with the long head tendon being most frequently affected. These tears often result from chronic overuse or an acute injury, such as a fall.
Distal bicep tears, which involve the single tendon attaching the bicep to the forearm bone at the elbow, are less common but often lead to greater arm weakness. These injuries occur due to a sudden force, such as lifting a heavy object. Tears are also classified by severity as either partial or complete. Partial tears involve damage to some soft tissue but do not completely sever the tendon, while complete tears fully detach the tendon from its bone attachment.
Immediate Care and Diagnosis
Upon suspecting a bicep tear, initial self-care steps can help manage symptoms before professional medical evaluation. The RICE method, which stands for Rest, Ice, Compression, and Elevation, is commonly recommended. Resting the injured arm by avoiding heavy lifting and overhead activities helps prevent further damage. Applying cold packs to the affected area for 20 minutes at a time, several times a day, can help reduce swelling and discomfort.
Compressing the area with a bandage can also help minimize swelling, and elevating the arm above the heart assists in reducing fluid accumulation. Seeking prompt medical attention is important for an accurate diagnosis and appropriate treatment plan. A healthcare provider will conduct a physical examination, assessing arm movement, strength, and looking for signs like bruising, swelling, or an abnormal bulge in the muscle, sometimes called a “Popeye sign,” which indicates a complete tear. Imaging tests like X-rays can rule out bone injuries, while ultrasound or magnetic resonance imaging (MRI) can provide detailed views of soft tissues to confirm the presence and extent of a partial or complete tear.
Treatment Approaches
Treatment for a torn bicep depends on several factors, including the tear’s location and severity, as well as the individual’s activity level and overall health. Many bicep tears, particularly partial tears or those affecting the shoulder in less active individuals, can be managed without surgery. Non-surgical approaches focus on pain relief and restoring function. This often involves pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), to reduce pain and inflammation.
Immobilization using a sling for a brief period can help protect the injured area during initial healing. Once pain subsides, gentle physical therapy exercises are introduced to regain range of motion and strengthen surrounding muscles. While non-surgical treatment can resolve symptoms over time, some mild arm weakness or a cosmetic deformity might persist.
Surgical repair is recommended for complete tears, especially distal tears at the elbow, or for active individuals, younger patients, and those who require full arm strength and function. The goal of surgery is to reattach the torn tendon to the bone. For proximal tears, a procedure called biceps tenodesis is performed, where the torn tendon is reattached to the upper arm bone. Distal bicep tears at the elbow require reattachment of the tendon to the forearm bone.
Rehabilitation and Recovery
Recovery from a bicep tear, whether treated non-surgically or surgically, involves a phased rehabilitation process aimed at regaining strength and function. This process is gradual, and individual timelines can vary based on factors like age, injury severity, and adherence to the rehabilitation plan. Physical therapy plays a central role in this recovery. A physical therapist guides patients through specific exercises that progress from restoring range of motion to building strength and improving functional movements.
Initially, exercises focus on gentle movements to prevent stiffness and promote healing. As healing progresses, strengthening exercises are introduced, targeting the bicep and surrounding muscles. For non-surgical cases, pain and discomfort from a proximal bicep rupture may subside within three to six weeks, though some weakness might remain. Distal tears treated non-surgically may take three to six months to fully heal.
Following surgical repair, the arm is immobilized in a sling or brace for several weeks, often four to six weeks. Physical therapy begins within one to two weeks after surgery. While light daily activities may be possible within two to three weeks, heavy lifting and vigorous activities are avoided for several months. Full recovery after surgery can take approximately four to six months, with some cases requiring up to nine months for complete healing, especially for complete tears. Adhering to the physical therapy program is important for optimizing recovery.