Biceps brachii tear/rupture
Upper arm musculature, along with rotator cuff muscles, acts as the main active stabilizer of the shoulder joint and provides functionality to the whole arm. Biceps brachii, the muscle at the anterior upper arm region connects to the top of the shoulder and the proximal part of the lower arm, to be exact, the origin of its long head is the coracoid process of the scapula, the short head originates from the supraglenoid scapular lump and the muscle descends along the humerus and connects to the proximal part of the radius bone in the lower arm. Biceps brachii performs elbow flexion, lifting of the arm and external lower arm rotation, ie. supination.
Rupture of biceps brachii tendon tissue reffers to a partial or complete tear of the colagen fibers that build the tendon tissue, in this case the commonly affected is the biceps brachii long head tendon. Causes of this injury can be of either traumatic nature, the tendon tears due to excesive force during a fall directly on the shoulder, and extended arm or when lifting a heavy object above shoulder level incorrectly. Tendon ruptures can also be caused by overload syndromes, ie. by longterm accumulation of microdamages on the tendon tissue and with time it weakens, degenerative changes occur and under the effects of an excesive force that tendon tissue tears.
Aging process, earlier injuries or poblems with the shoulder that have not been timely or properly treated and repetitive arm lifting above shoulder level are all seen as possible risk factors for biceps brachii tendon rupture. When this injury takes place a sharp and sudden pain can be felt, the joint swells and a hematoma appears. Shoulder movements can not be performed and elbow flexion as well as lower arm supination are limited.
Treatment depends on the gravity, ie. level injury, with partial tears a conservative treatment approach can be implemented. RICE method and other physical therapy methods are used to reduce pain, sweeling and hematoma and immobilisation can be put on the arm to proliferate tendon healing. Afterwards, in the functional phase of therapy, shoulder mobility, upper arm, subscapular, chest and rotator cuff muscle strenght as well as shoulder and elbow stability should be regained. After an operative approach, ie. surgical reconstruction or stitching of the tendon an orthosis immobilisation is and the arm should bear no weight for 4-6 weeks. The tendon repair should take place very soon after the injury occured in order to prvent excesive shortening of the injured tendon tissue. After the orthosis is taken down permanently a gradual, progressive shoulder and upper arm strength and stability program should be implemented and a full return to every day activities is expected in 4-6 months.
Prevention: proper warm up and stretching regime during sports activities, proper and timely treatment of earlier shoulder injuries/damage, avoiding repetitive arm lifting above shoulder level and implementing preventive strenght and stability programs for individuals whose jobs or sports activities require those movements frequently, etc.
Umer Butt, MD, MRCS (UK), FRCS T&O (UK), Senior Consultant Orthopaedic Surgeon
Rehabilitation program author
Dr Butt is a full time Senior Consultant Orthopaedic Surgeon Specialist in Knee/Shoulder Sports Injury, Arthroscopy and Arthroplasty Circle Bath Hospital UK AO Clinic Centre for Orthopaedic, Trauma and Sports Injury KarachiGo to profile
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