Biceps tendon is the muscle that forms the anterior part of the upper arm and which contributes to the shoulder movements as well as the flexing and rotating movements of the forearm.
The rupture of a biceps tendon can mainly occur near the proximal end or at the distal end. Since the proximal portion of the biceps muscle originates from two heads, either one can be involved in a rupture. But, in most instances, the tendon that is susceptible to suffer is the long head of the biceps muscle. When considering the distal end, the insertion into the radial tuberosity of the humarus can be the most susceptible point for a tendon rupture or in better terms an avulsion injury.
Patients will be referred to the orthopedic surgeon with complaints such as severe pain, restricted movements, swelling, snapping sound at the time of the rupture or as an incidental finding. Once it has been determined to be a biceps tendon rupture, the treatment options needs to be adjusted according to the age, lifestyle, requirement, underlying risk factors and the severity of the illness.
Having made all these considerations, the surgeon will recommend a treatment option and it would not always be surgical.
1. Conservative management
Elderly patients, as well as in patients who can tolerate a mild loss of strength in flexion of arm from the elbow and more specifically the supination movement, will undergo conservative treatment rather than the surgical option.
Initially, the arm will be put on a soft sling and thereafter will be gradually introduced to movements by a physiotherapist. Cold packs and electrical stimulations can ease the pain present in the joint and would take several weeks before the patient will be able to undertake their normal day to day work.
These patients need to be put on anti-inflammatory medications to relieve pain and associated swelling.
2. Surgical method of management
The surgical procedure involved in repairing the biceps tendon in a complex procedure and will depend on the extent of the injury as well as the position.
Another factor that affects the surgical procedure is the presence of long term wear and tear within the shoulder joint as demonstrated by degeneration of the biceps tendon. In such instances, the surgeon will be looking at easing these stressors and prevent any further degeneration from taking place apart from reparing the ruptured tendon.
There are two types of surgeries that are being used; one is 'biceps tenodesis' and the other is known as 'acromyoplasty and direct tenodesis'.
Following the surgical procedure, the patients will not be able to bear weight for about 4 weeks and the arm will be rested on a soft sling. Thereafter the patient can be introduced to light exercises which do not exert pressure at the site of the wound. In some instances, the surgeons might prefer to make the patients start mobilizing the arm as soon as possible.
A physiotherapist will gradually introduce the patients initially to isometric exercises and secondarily to exercises which builds up the joint stability and muscle strength.
The recovery will be slow and sometimes painful in the initial stages. Therefore, these patients will be given pain relief in the initial stages in the forms of anti-inflammatory drugs, electrical stimuli, massages or cold compressions.
Once the pain and the other associated symptoms disappear it may be time for the patients to become involved in their normal day to day activities.