Rupture of the biceps tendon

Anatomy: The biceps muscle (M biceps brachii) has two tendons, fastened on the shoulder blade. One tendon (caput longum) passes through the shoulder joint. The two tendons join the biceps muscle on the upper arm and are anchored just below the elbow on the forearm. The function of the biceps muscle is to bend the elbow and supination (rotation) of the forearm. The long head of the biceps tendon has a tendon sheath that communicates with the shoulder joint.

Symptoms: Sudden insetting localised tenderness exterior and to the front of the shoulder after load. Sometimes radiating down the upper arm. Pain is aggravated when external pressure is applied to the biceps tendon, the front of the shoulder, when the muscle is activated (attempting to bend the arm against resistance) and when the muscle is taut (stretching and at the same time rotating inwards in the elbow (pronating)). A swelling can often be observed (the contracted biceps muscular belly) above the bend of the arm (cubital fossa).

Acute treatment: Click here.

Examination: In case of sudden insetting pain and swelling above the elbow a medical examination should be carried out to ensure the correctness of the diagnosis and to commence the correct treatment. Normal medical examination is often sufficient to form the diagnosis, but if any doubts exist the examination should be supplemented by an ultrasound scan, which is the most suited examination for shoulder injuries (article) (Ultrasonic image).

Treatment: The treatment consists of relief and slow rehabilitation of the biceps muscle and the other muscles around the shoulder. Only in cases of total rupture of the biceps muscle should surgery be considered, as the vast majority of ruptures are treated with rehabilitation.

Complications: If smooth progress is not achieved the correctness of the diagnosis should be considered, or whether complications have arisen. Amongst others the following should be considered:

• Inflammation of the biceps
• Rupture of the upper shoulder blade muscle
• Inflammation of the upper shoulder blade muscle
• Rupture of the lower shoulder blade muscle
• Inflammation of the bursa (bursitis subacromiale)
• Impingement syndrome
• Rupture of the deltoid muscle
• Partial luxation of the shoulder joint
• Luxation of the joint between the shoulder blade and the collarbone
• Frozen shoulder
• Muscle infiltrations
• Sprained shoulder (distorsio art. humeroscapularis)
• Meniscus lesion in the shoulder (laesio labrum glenoidale)
• Nerve entrapment on the back of the shoulder blade

…and pain inside the shoulder (the fluid in the biceps tendon may emanate from the shoulder joint).