Discharge Instructions for Suspected Biceps Brachii Tear in Primary Care
For suspected biceps tears, provide initial conservative management with rest, ice, compression, and elevation (RICE), early range of motion exercises, and appropriate pain management, while referring for imaging and specialist consultation for complete tears or those with significant functional limitations.
Initial Assessment and Management
Immediate Care Instructions
- Rest: Advise the patient to avoid activities that cause pain, particularly lifting and overhead movements
- Ice: Apply ice for 15-20 minutes every 2-3 hours for the first 48-72 hours
- Compression: Use an elastic bandage to provide gentle compression
- Elevation: Keep the arm elevated when possible to reduce swelling
Pain Management
- Recommend acetaminophen and NSAIDs (if not contraindicated) for pain control 1
- Limit opioid use to cases of severe pain only, and only for short duration 1
- Instruct on proper dosing and timing of medications
Imaging Recommendations
When to Order Imaging
- Initial radiographs (3-view series: anteroposterior, lateral, and oblique) should be obtained to rule out fractures, dislocations, or avulsion injuries 1
- For suspected tendon tears:
Imaging Pitfalls
- Be aware that ultrasound accuracy is highly dependent on the operator's expertise - examinations by non-specialists have shown sensitivity as low as 40% compared to 91% for specialists 2
- Avoid premature advanced imaging before appropriate clinical assessment 1
Rehabilitation Instructions
Early Mobilization
- Begin gentle range of motion exercises within 1-2 weeks to prevent stiffness 1
- Avoid prolonged immobilization which can lead to elbow stiffness 1
Progressive Rehabilitation
- Gradual progressive strengthening exercises should begin after 1-2 weeks 1
- Provide specific exercises based on the location and severity of the tear:
- For proximal tears: focus on shoulder and elbow mobility first, then gradual strengthening
- For distal tears: focus on elbow mobility with careful attention to supination movements
Follow-up Recommendations
Timing of Follow-up
- Schedule follow-up within 1-2 weeks to assess progress
- Regular monitoring is essential, especially for partial tears managed conservatively 1
Red Flags Requiring Immediate Attention
- Severe pain unresponsive to analgesics
- Progressive weakness or loss of function
- Signs of compartment syndrome (pain out of proportion to injury, pain with passive stretching, paresthesia, pallor, pulselessness) 1
Specialist Referral Guidelines
When to Refer
- Complete tears typically require early surgical intervention for better outcomes 1
- Partial tears >50% may require surgical treatment similar to complete tears 1
- Distal biceps tendon ruptures should be referred promptly as early surgical reattachment (within 2-3 weeks) provides optimal results 3
- Patients with significant functional limitations despite conservative management
Expected Outcomes
Conservative management can be successful in certain cases, particularly for proximal tears. A case report of a proximal full-thickness biceps brachii muscle tear treated conservatively showed no functional limitations or pain at 6-month follow-up, though strength deficits remained (39.1% decrease in elbow flexion peak torque) 4.
Patient Education
- Explain the nature of the injury and expected recovery timeline
- Emphasize the importance of adherence to the rehabilitation protocol
- Inform that complete recovery may take 3-6 months depending on severity
- Advise that some strength deficits may persist even with appropriate treatment