From the Guidelines
A biceps tendon rupture typically results in a significant loss of function, primarily affecting elbow flexion strength and supination, with patients experiencing a reduction in elbow flexion strength and supination strength, although the exact degree of functional loss can vary depending on the location and severity of the rupture. The loss of function associated with a biceps tendon rupture can be attributed to the disruption of the tendon's attachment to the bone, leading to a decrease in the muscle's ability to generate force and control movement. According to a study by Nicolay et al [@24@], partial rupture of the long head of the biceps with an intact short head of the biceps is the most common injury, and traumatic ruptures have a significantly higher association with ruptures of the short head of the biceps tendon.
Some key points to consider when evaluating the loss of function associated with a biceps tendon rupture include:
- The degree of functional loss depends on whether it's a proximal (shoulder) or distal (elbow) rupture, with distal ruptures generally causing more noticeable functional deficits [@21@, @22@, @23@, @24@]
- Other muscles like the brachialis and brachioradialis can compensate for elbow flexion, while the supinator muscle helps with forearm rotation [@24@]
- Treatment options include conservative management with physical therapy for less active individuals or those with proximal ruptures, or surgical repair for younger, active patients and those with distal ruptures [@25@, @26@, @27@]
- Surgery typically provides better strength recovery, especially for supination, but carries surgical risks [@28@]
It's worth noting that the use of MRI and US can be helpful in assessing biceps tendon ruptures, with MRI having an improved sensitivity for the detection of partial tears of the biceps and triceps tendons 1. However, the choice of imaging modality depends on the specific clinical scenario and the availability of resources. Ultimately, the goal of treatment is to restore function and minimize morbidity, mortality, and impact on quality of life.
From the Research
Loss of Function Associated with Biceps Tendon Rupture
The loss of function associated with a biceps tendon rupture can be significant, with patients experiencing:
- Weakness in elbow flexion and forearm supination 2, 3, 4, 5, 6
- Reduced range of motion, particularly in flexion and supination 3, 4
- Pain and disability, especially with activities that require power during elbow flexion and forearm supination 6
- Potential long-term complications, such as heterotopic ossification and nerve damage 3, 4
Clinical Presentation
Patients with a biceps tendon rupture may present with:
- Acute antecubital pain and weakness of elbow flexion and forearm supination 5
- Vague elbow pain and weakness, especially in cases of partial rupture 2
- Reduced supination and pronation strength 4
- Potential palpability of the biceps tendon in cases of partial rupture 5
Treatment and Rehabilitation
Treatment of biceps tendon rupture can involve:
- Surgical repair, which can provide consistently good results and restore strength and endurance for the elbow 4
- Conservative management, which may be suitable for partial tears involving less than 50% of the tendon 2, 5
- Rehabilitation programs that progress in a phased manner, avoiding premature stress to the healing soft tissue repair 6