Imagine that you are lifting something heavy and suddenly you hear a 'click' sound from the upper part of your arm and feel a sharp pain. Or sometimes the muscle in your arm looks strangely swollen like a lump. This could be a condition you have probably heard of called Biceps Rupture. Many people are scared when they hear this name, but if we know exactly what it is, there is nothing to be afraid of. So, today we will talk about this.
Simply put, what is this Biceps Rupture?
The muscle in your upper arm that comes up when you bend your arm is called the biceps muscle. This muscle is attached to the bones in your shoulder and a bone near your elbow by strong cord-like tissue. We call this tendon.
Simply put, a biceps rupture is a tear in the strong tendon tissue. This tear can be complete or it can be partial.
Our biceps muscle is attached to the bones by three main tendons:
- Two near the shoulder (Long head tendon and Short head tendon)
- One near the elbow (Distal biceps tendon)
We classify this condition according to where the tendon ruptures.
- Proximal Biceps Tendon Rupture: This occurs when a tendon near the shoulder tears. This is the most common type.
- Distal Biceps Tendon Rupture: This occurs when the tendon near the elbow ruptures. This is less common, but can be quite serious.
What happens to the function of the arm when the biceps is torn?
When the biceps is torn, the ability to use the arm is affected. But it depends on where the tendon is torn and how badly it is torn.
Most often, the tendon is torn near the shoulder, and other muscles in the arm (such as the Brachialis and Supinator) come to the rescue and help move the arm. So you will still be able to move your arm. However , you may feel stiffness and weakness when lifting weights or turning your arm (such as tightening a screw).
If the tendon ruptures near the elbow (distal rupture), it is a little more serious. Although you can move your arm back and forth, the strength of your arm is significantly reduced. In particular, since the arm is turned under the elbow, the ability to turn the arm up (supination) is largely lost. When lifting objects, when gripping tightly, the arm will feel like it has no strength. For people who need full strength in their arm, such as athletes, surgery is usually required in such cases.
Why does a biceps tendon tear like this?
There can be two main reasons for this: either due to an accident, or because the tendon has worn out and weakened over time.
An accident is something like "when you suddenly reach for something heavier than you think, and apply a lot of force to straighten your arm." It can also be caused by things like hitting the ground with your arm outstretched when you fall, or suddenly twisting your arm or shoulder.
| Factors that increase the risk of a biceps rupture | |
|---|---|
| Passing over time | Tendons naturally weaken as we age, and repetitive shoulder activities (e.g., swimming, baseball, some jobs) can cause the tendon to wear out. |
| Other shoulder problems | The biceps tendon can be damaged by other shoulder conditions, such as tendonitis, bursitis, or a rotator cuff tear. |
| Smoking | Smoking reduces the blood supply to the tendons, making them weak and slowing down the healing process. |
| Lack of physical activity | Muscles and tendons weaken when you don't exercise. |
| Some medications | Long-term use of medications such as corticosteroids can weaken muscles and tendons. |
What are the symptoms of this?
If you have a biceps rupture, you may experience one or more of these symptoms:
- Hearing a 'tock' or 'pop' sound at the time of the accident.
- Sudden, severe pain in the shoulder or elbow (depending on the location of the tear).
- Feeling weak in the arm or shoulder.
- The upper arm is blue and looks like a bruise .
- Feeling like you are having cramps in your muscles when using your hand.
- Difficulty rotating the arm (turning the wrist up and down).
- "Popeye Muscle" feature: This is often seen near the shoulder (proximal rupture). Just like Popeye in the cartoon, your biceps muscle looks like a lump and bulges out. This is called `(Popeye deformity)`.
How does the doctor determine if this is a biceps rupture?
A doctor can usually diagnose this by examining you physically. He or she will check your arm's range of motion and strength. Sometimes, if the tear is not complete or not clear, a scan such as an X-ray, ultrasound, or MRI may be done.
And there are two special tests to confirm this:
1. Hook Test: While you bend your elbow and rotate your arm, the doctor will try to grab the tendon on the back of your elbow with his finger. If it is clearly caught, you can assume that the tendon is not torn.
2. Biceps Squeeze Test: The doctor will support your elbow and gently squeeze your upper arm. If your forearm does not spontaneously turn outward, this could be a sign that the tendon has torn.
The most important thing is to see a doctor as soon as possible after these symptoms appear. Treatment within the first three weeks is much easier and complications are less likely. If left too late, the tendon can become inflamed and scarred, making treatment, especially surgery, more complicated.
What are the treatments for this?
The treatment you receive will depend on whether the tendon is torn near the shoulder or elbow, and how severe the tear is.
Cases where surgery is not required (Non-Surgical Treatment)
If the tendon is not completely torn (partial tear), your doctor may recommend treatments such as:
- Ice: Apply ice to the area of pain and swelling for about 20 minutes, several times a day.
- Rest: Avoid heavy lifting and strenuous activities for a while. You may be advised to use a sling.
- Painkillers: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help reduce swelling and pain. However, you should always check with your doctor to make sure they are right for you.
- Physical Therapy: Exercises performed under the guidance of a physical therapist can help with the healing process and strengthen other muscles in the hand.
Surgery
If the tendon is completely torn, especially near the elbow (distal rupture), your doctor is more likely to recommend surgery. "A tendon that is torn near the elbow will not heal on its own. The muscle will not be able to function properly again."
Surgery may also be recommended in cases like these:
- If other treatments do not relieve the pain.
- If the biceps muscle keeps cramping.
- If you are unable to perform daily activities due to shoulder pain and weakness.
The surgery involves reattaching the torn tendon to the bone. This may involve using small metal pins (anchors) or buttons. In most cases, this surgery can be done through a series of small incisions, called arthroscopic surgery, with the help of a camera.
After surgery, you will need to wear a splint or cast for a while. After that, you can gradually regain strength and movement in your hand through physical therapy.
How long does it take to recover?
A minor tear that does not require surgery may heal in a few weeks. However, if surgery is performed, it may take two to three months for the tendon to heal back to the bone. It may take another month or two for your hand to regain full strength. It is important to ask your doctor how long you should wait before you resume heavy work or sports and follow their instructions.
Take-Home Message
- Biceps Rupture is the tearing of a tendon that connects the biceps muscle to the bone in the arm.
- The main symptoms may include sudden pain, a 'pop' sound, weakness in the arm, and a bulging muscle ('Popeye muscle').
- Treatment options depend on the nature of the tear and range from rest to surgery.
- The most important thing is to seek medical advice quickly. See your doctor as soon as you notice these symptoms. The sooner you start treatment, the better the results.
- With proper treatment, most people can regain full function and strength in their hands. So don't worry.
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