A Biceps tendon tear injury is a shoulder dysfunction that I see quite often amongst older adult Patients. It occurs due to a fall on an outstretched arm or when lifting a heavy object that causes sudden sharp pain into the front of the shoulder. Common signs of Biceps tendon tear include Weakness and pain on rotating the arm inwards and outwards and difficulty bending the elbow against resistance.
The Biceps tendon is located on the front of the shoulder joint. Its tendon attachment into the shoulder divided into 2 parts or ‘heads’, known as the Long Head of the Biceps muscle and the Short Head of the Biceps muscle. When a tear occurs to the Long Head of Biceps tendon, the patient is able to continue bending the elbow and rotating the arm due to the fact that the Biceps Short head tendon is still intact and is hence double jobbing. Older patients from 40 years upwards are susceptible to this injury because of the degenerative changes that can occur in the Biceps tendon.
How is the Biceps tendon torn?
Falling on an outstretched arm
During the swinging action when playing Golf or Tennis
Lifting a heavy object such as a Farmer lifting a gate or carrying a heavy bucket causes traction pressure on the Tendon head causing a sudden tear.
Signs & Symptoms
Patients experience a sudden sharp pain in the front of the shoulder
Tenderness, Swelling and Pain at the front of the shoulder Joint.
Unable to bend the elbow against resistance in the first week of injury.
Weakness and pain when turning the palm of the hand facing upwards to the ceiling
Cramping can develop in the belly of the biceps with use.
General weakness develops in the shoulder and elbow joint
In cases of a complete tear of Long head of Biceps tendon, visible lump can develop above the elbow in the biceps muscle
Management & Treatment
Once the Physical therapist confirms that the tendon is not fully torn the rehabilitation process can begin by encouraging the heeling process in the partially torn biceps tendon. This is achieved through the use of ultrasound, manual techniques such as Friction coupled with ice. Gentle low grade strengthening exercises needs to initiated in order to gradually build up the tensile strength of the tendon. Avoidance of lifting heavy objects is essential.
Tomás Ryan is a Registered Physical Therapist (MIAPT) with The Irish Association of Physical Therapy and is based in Thurles.
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