The biceps muscle is a bipennate muscle (two muscle bellies). The two components are called the short head and the long head biceps tendon. Each muscle has an associated tendon. The end of the muscle closer to the elbow generally has a convergence of the two muscle bellies and has one tendon called the distal biceps tendon. The end of the muscle closer to the shoulder has two discrete tendons called the short head biceps tendon and the long head biceps tendon.
When an athlete or patient sustains an injury or in the absence of injury develops persistent symptoms, they should seek medical attention from a fellowship trained sports medicine specialist. While the diagnosis can often be made based upon the history and clinical exam, an MRI is often obtained to analyze the injury completely.
Prevalence of Injury:
Each of these three tendons can tear. Of the three tendons, the long head biceps tendon near the shoulder is the more commonly torn, next is the distal biceps tendon near the elbow and the short head biceps tendon near the shoulder is rarely torn.
The long head biceps tendon can tear without trauma in patients older than 45 and this usually occurs in conjunction with rotator cuff tendon tears. These tears are often life-related, associated with more of a degenerative process and can occur in males and females.
In the younger active population or athletes the long head biceps tendon can tear secondary to trauma (such as lifting a heavy box or at the time of a fall on an outstretched arm) or sports. In sports these injuries are often related to Biceps Labral Complex tears associated with the attachment site within the shoulder joint. These injuries can occur in throwing athletes, elite swimmers, athletes involved in collision sports or weight trainers. These tears are sustained in both males and females.
The distal biceps tendon tears occur in younger patients often associated with trauma and in athletes engaged in weight training and collision sports. Occasionally, these tears are sustained in older patients who attempt to for example, open a window that is stuck. It should be noted that there is a gender specific difference in that most of these Distal Biceps Tendon tears occur in males.
Bicep Tear Treatment:
In general, distal biceps tendon tears should be treated with surgical repair in most active healthy patients, while long head biceps tendon tears should be evaluated carefully to determine whether it is an isolated long head biceps tendon tear or combined with an associated rotator cuff tendon tear or a biceps labral complex tear. This typically will require an MRI for a thorough analysis. Treatment is predicated upon the results. Isolated Long Head Biceps Tendon tears are sometimes treated non-operatively in older, lower demand patients. Younger patients and athletes will benefit from surgical repair that is termed a tenodesis in which the tendon is reattached in an appropriate location to restore function and secondarily to improve cosmesis. Combined injuries that include rotator cuff tendon tears and/or biceps labral complex injuries generally require surgery for a satisfactory outcome with respect to pain relief and return to activity.
Returning to Full Activity:
When surgery has been recommended, the athlete should seek consultation from a fellowship trained (in sports medicine or shoulder and elbow surgery) orthopedic surgeon.
These repairs typically require several months for the athlete to get back to their prior level of sports activity. There is a period of biologic healing with certain restrictions during the first 4 weeks following surgery. Progressive range of motion begins in the second month with early strength and conditioning beginning after 10-12 weeks.
Dr. Frank Cordasco is an Orthopedic Surgeon in the Sports Medicine and Shoulder Service at Hospital for Special Surgery. The primary focus of Dr. Cordasco’s practice includes ACL and meniscus injury in the pediatric, adolescent, and adult athlete; shoulder instability; biceps tendon tears, rotator cuff and pectoralis tendon repairs, clavicle fracture surgery and AC joint separations. Dr. Cordasco’s research and education activities parallel and complement these clinical areas of expertise.