The biceps muscle bends the arm at the elbow and rotates the forearm in order to allow the palm of the hand to face upward. It is located at the front of the arm and is attached by the biceps tendon to the shoulder blade (scapula) and the radius bone.

The biceps muscle separates near the shoulder into a long head and a short head – both of which attach to the shoulder in different places. The long head of the biceps tendon is subject to injury because it travels through the shoulder joint to its area of attachment.

A biceps tendon rupture may occur as a result of chronic tendonitis – and a long history of shoulder impingement and stability problems. While ruptures of the distal tendon near the elbow are less reported than those of the proximal tendon, they can occur with unexpected force on a bent arm in breaking a fall or shielding from a collision.

Most frequently diagnosed are ruptures of the proximal biceps tendons near the shoulder. Because of the broad range of motion the shoulder joint can attain and to which it is subjected, the proximal biceps tendon is more vulnerable to injury than the distal biceps tendon.

Proximal biceps tendons tears can be either partial or complete and are often times already a bit worn – particularly in the patient over 40 years of age.

Pain is usually sharp and sudden, often times preceded by a loud “snap.” There may be a bulge in the upper arm above the elbow and an indention nearer the shoulder – possibly accompanied by bruising, pain or tenderness.

Those at Risk
Athletes subjecting their shoulder to extreme throwing force are vulnerable and likely to experience this condition during their career. Active adults who over exert in an activity, or who have a history of shoulder instability problems and degenerative tendon conditions are also at risk. In the elderly, proximal biceps tendon ruptures (in the shoulder area) are generally seen in conjunction with rotator cuff tears.

Diagnosis
Along with patient history, a physical examination involving arm movement and tightening of the biceps muscle will help determine diagnosis. For patients with a history of shoulder pain and instability, magnetic resonance imaging (MRI) or arthrogram (enhanced X-ray) may be indicated, in order to assess the condition of the rotator cuff muscles.

Treatment
Conservative nonsurgical treatment is usually successful in treating biceps tendon ruptures. This may entail cold compression in order to reduce swelling, nonsteroidal anti-inflammatory drugs (NSAIDs), and a period of rest followed by a rehabilitative strengthening and flexibility program that is specific to the patient.

When the condition is nonresponsive to conservative treatment, surgery to repair the tendon tear may be performed. This depends on the patient’s history, age and work requirements.

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