From the Guidelines
A biceps tendon rupture is a serious injury that requires prompt evaluation and treatment, and the most effective treatment approach depends on the location and severity of the rupture, with surgical repair being the recommended treatment for complete tears, especially in younger, active patients. The symptoms of a biceps tendon rupture include a sudden "pop" sensation, pain, swelling, bruising, weakness, and a visible deformity called a "Popeye muscle" where the biceps bunches up in the arm 1.
Diagnosis and Treatment Options
The diagnosis of a biceps tendon rupture can be made using MRI or US, with MRI being more accurate in detecting partial tears and tendinopathy 1. The treatment options for a biceps tendon rupture include:
- Conservative management, including rest, ice, compression, elevation (RICE), NSAIDs like ibuprofen (400-600mg three times daily) for pain and inflammation, and physical therapy for 6-12 weeks, which is often recommended for partial tears or in elderly patients with limited activity demands 1
- Surgical repair, which involves reattaching the tendon to bone using anchors or sutures, and is typically required for complete tears, especially distal ruptures or in younger, active patients 1
Post-Surgery Rehabilitation
Post-surgery, patients need to wear a sling for 4-6 weeks, followed by progressive rehabilitation for 3-6 months 1. The rehabilitation program should include exercises to improve range of motion, strength, and function, and should be tailored to the individual patient's needs and goals.
Importance of Prompt Evaluation
Prompt evaluation by an orthopedic specialist is essential to determine the appropriate treatment approach, as delayed treatment can lead to poor outcomes, including decreased strength and function, and increased risk of complications 1.
Key Points to Consider
- The location and severity of the rupture are critical factors in determining the treatment approach
- Surgical repair is the recommended treatment for complete tears, especially in younger, active patients
- Conservative management may be appropriate for partial tears or in elderly patients with limited activity demands
- Prompt evaluation and treatment are essential to achieve optimal outcomes
- Rehabilitation is a critical component of the treatment plan, and should be tailored to the individual patient's needs and goals 1
From the Research
Symptoms of Biceps Tendon Rupture
- Ruptures of the distal biceps tendon are most commonly due to traumatic eccentric loading in the middle-aged male population and can result in functional deficits 2
- The loss of power regarding elbow flexion and supination amounts to 8 to 21% after conservative treatment 3
- Ruptures of the long head of the M. biceps humeri are commonly caused by degenerative changes within the tendon 3
- Biceps tendon rupture can result in weakness and deformity 4
Treatment Options for Biceps Tendon Rupture
- Operative management was associated with a significantly higher flexion strength, supination strength, flexion endurance, and supination endurance compared to nonoperative management 2
- Patient-reported DASH and MEPS were also significantly superior in patients who underwent surgical repair 2
- Many techniques and fixation devices have been described for surgical reinsertion, but in the literature, there are no clinical evidences that show the superiority of any of these 5
- The choice of surgical technique remains controversial, and the double approach transosseous reinsertion is a safe, costless and relatively non-invasive technique, offering satisfactory results when performed early 5
- The adequate method of repair is to be determined individually 3
- UK upper limb surgeons currently advise surgical repair of acute distal biceps tendon ruptures for the majority of their patients 4