What is the management approach for a bicep (biceps brachii) tear?

From the Guidelines

Management of a bicep tear should prioritize a treatment approach based on the severity of the injury, with recent evidence suggesting that MRI is a highly sensitive tool for detecting partial tears of the biceps and triceps tendons 1.

Key Considerations

• For partial tears, conservative management is typically recommended, including rest, ice application, compression, and elevation of the arm, as well as pain control with NSAIDs such as ibuprofen or naproxen for 1-2 weeks.
• Physical therapy should begin after the acute phase, focusing on gentle range of motion exercises followed by progressive strengthening over 6-12 weeks.
• Complete tears, especially of the distal biceps tendon, often require surgical repair within 2-3 weeks of injury for optimal outcomes, particularly in active individuals who need full arm strength.

Diagnostic Approach

• MRI is particularly useful in the assessment of biceps tears, with improved sensitivity for the detection of partial tears of the biceps and triceps tendons 1.
• The use of noncontrast MRI in the assessment for ligamentous and tendinous injury has been evaluated in several studies, showing good interobserver agreement in the assessment of lateral collateral complex injuries 1.
• Ultrasound (US) can be considered an alternative to MRI in the evaluation of distal biceps tendon ruptures, with recent studies showing substantial interreader agreement 1.

Treatment Outcomes

• Surgical repair can restore up to 95% of strength in complete tears, while conservative management of complete tears may result in 30-40% strength deficit and potential cosmetic deformity ("Popeye muscle") 1.
• The decision between conservative and surgical management should consider the patient's age, activity level, and functional demands.

Rehabilitation

• Surgery is followed by immobilization for 1-2 weeks and a structured rehabilitation program lasting 3-6 months.
• Rehabilitation should focus on restoring range of motion, strength, and function, with a gradual progression of exercises and activities.

From the Research

Management Approach for Bicep Tear

The management approach for a bicep tear can be divided into conservative and surgical treatments.

• Conservative treatment includes rest, ice, oral analgesics, physical therapy, or corticosteroid injections into the biceps tendon sheath 2.
• Surgical treatment should be considered if conservative measures fail after three months, or if there is severe damage to the biceps tendon 2.

Treatment Options for Partial Distal Biceps Tendon Rupture

For partial distal biceps tendon rupture, treatment modalities include conservative management or surgery 3.

• Conservative management consists of immobilization, medication, and physical therapy.
• Surgical treatment involves repair of the torn tendon.
• Both treatment options produce good clinical outcomes, but conservative treatment had poorer outcomes in terms of strength after treatment, while surgical treatment had more complications 3.

Treatment Algorithm for Type-II SLAP Tears

A treatment algorithm for Type-II SLAP tears based on current literature and expert opinion recommends:

• Operative management for patients with failed non-operative management or severe pathology 4.
• Biceps tenodesis for patients over 40 years old or with significant proximal biceps pathology.
• Primary SLAP repair for patients under 40 years old with no evidence of proximal biceps pathology.
• Tenotomy for elderly or low-demand individuals 4.

Conservative Treatment of Proximal Full-Thickness Biceps Brachii Muscle Tear

Conservative treatment of a proximal full-thickness biceps brachii muscle tear can be effective, as seen in a case report of a 23-year-old male patient who underwent 6 months of conservative treatment consisting of therapeutic exercise, manual therapy, and cryotherapy 5.

• The patient reported no functional limitations or pain at the 6-month follow-up.
• Isokinetic testing revealed a decrease in elbow flexion peak torque and total work output.

Treatment of Partial Distal Biceps Tendon Tears

For partial distal biceps tendon tears, treatment options depend on the extent of the tear:

• Tears <50% may be treated with nonoperative management or surgical debridement of the surrounding synovitis 6.
• Tears >50% should be treated with division of the remaining tendon and surgical repair of the entire tendon as a single unit.
• Surgical endoscopy can be used to quantify the extent of the tear and treat with debridement, but should only be used in experienced hands 6.