Tear or rupture of the biceps tendon at the elbow is a fairly common injury. The biceps muscle lies superficially in the anterior aspect or front of the arm. It originates in the shoulder area and inserts on the radius just below the elbow and functions to flex or bend the elbow and supinate or rotate the forearm. Biceps tendon tears occur most commonly in males aged 40 to 60 years in the dominant arm. Mechanism of injury is usually forced extension of a flexed elbow resulting in an eccentric contraction of the biceps muscle and avulsion of the tendon from its insertion on the tuberosity of the radius.
Diagnosis of a biceps tendon rupture can be made with a careful history, physical examination and radiographic studies. Patients commonly report a forced extension injury to a flexed elbow resulting in a sharp pop or tearing sensation and immediate onset of pain in the anterior elbow. Pain typically resolves in a few days. Physical examination usually shows an obvious deformity of the biceps muscle as it retracts superiorly in the arm. Tenderness is noted over the anterior elbow and a palpable defect is usually present. Swelling and bruising are commonly seen over the front of the elbow. Muscle weakness in supination and to a lesser extent in flexion is found. Plain radiographs (X-rays) are usually normal.
A magnetic resonance imaging (MRI) scan of the elbow is often unnecessary to diagnose a complete biceps tendon tear but may be helpful in the diagnosis of a partial tendon tear. Treatment of a complete biceps tendon tear is either surgical or nonsurgical. Nonsurgical treatment is reserved only for older, less active patients who do not require full strength in their arm. Surgical repair can be performed as an outpatient using a variety of techniques. Surgery involves reattachment of the torn tendon to the radius through one or two incisions with fixation using suture anchors or suture through bone tunnels. In patients in whom the diagnosis of biceps tendon rupture is delayed for four to six weeks, use of a tendon graft may be necessary for repair. In order to properly diagnose and treat a biceps tendon problem, an evaluation by an orthopedic surgeon is necessary.
