Biceps Tendon Disruption (Proximal)

with Rehab

ExitCare ImageThe biceps tendon attaches the biceps muscle to the bones of the elbow and the shoulder. A proximal biceps tendon disruption is a tear of the long head of the tendon that attaches near the shoulder (more common) or a tear in the muscle near the muscle tendon junction (less common). These injuries usually involve a complete tear of the tendon from the bone. However, partial tears are also possible. The biceps muscle works with other muscles to bend the elbow and rotate the palm upward (supinate). A complete biceps rupture will result in about a 10% decrease in elbow bending strength and a 20% decrease in your ability to turn the palm upward, using the wrist.

SYMPTOMS

  • Pain, tenderness, swelling, warmth, or redness over the front of the shoulder.

  • Pain that gets worse with shoulder and elbow use, especially against resistance (lifting or carrying).

  • Bruising (contusion) in the arm or elbow after 24 to 48 hours.

  • Bulge can be seen and felt in the arm.

  • Limited motion of the shoulder or elbow.

  • Weakness with attempted elbow bending or rotation of the wrist, such as when using a screwdriver.

  • Crackling sound (crepitation) when the tendon or shoulder is moved or touched.

CAUSES

A biceps tendon rupture occurs when the tendon is subjected to a force that is greater than it can withstand. For example, a sudden force straightening the elbow while the biceps is flexed, or a direct hit (trauma) (rare).

RISK INCREASES WITH:

  • Sports that involve contact, or throwing and overhead activities (racquet sports, gymnastics, weightlifting, bodybuilding).

  • Heavy labor.

  • Poor strength and flexibility.

  • Failure to warm up properly before activity.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Allow your body to recover between practices and competition.

  • Learn and use proper exercise technique.

PROGNOSIS

If treated properly, the symptoms of a proximal biceps tendon disruption usually go away within 12 weeks of injury.

RELATED COMPLICATIONS

  • Longer healing time if not properly treated, or if not given enough time to heal.

  • Recurring symptoms, especially if activity is resumed too soon.

  • Weakness of elbow bending and forearm rotation.

  • Prolonged disability (uncommon).

TREATMENT

Treatment first involves the use of ice and medicine, to reduce pain and inflammation. It is also important to perform strengthening and stretching exercises and to modify activities that cause symptoms to get worse. These exercises may be performed at home or with a therapist. It is not possible to surgically fix the tendon (sew it together). However, surgery may be performed to reinsert the tendon into the arm bone. This will make the arm look normal again. Surgery is most often advised for younger, active individuals, especially those who require strength of wrist rotation.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given if your caregiver thinks they are needed. Use only as directed and only as much as you need.

  • Corticosteroid injections may be given to help reduce inflammation, but are not usually recommended for this injury.

HEAT AND COLD

  • Cold treatment (icing) should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 weeks, despite treatment.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Biceps Tendon Disruption (Proximal)

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may go away with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

ExitCare Image STRETCH – Flexion, Standing

  • Stand with good posture. With an underhand grip on your right / left hand and an overhand grip on the opposite hand, grasp a broomstick or cane so that your hands are a little more than shoulder width apart.

  • Keeping your right / left elbow straight and shoulder muscles relaxed, push the stick with your opposite hand to raise your right / left arm in front of your body and then overhead. Raise your arm until you feel a stretch in your right / left shoulder, but before you have increased shoulder pain.

  • Try to avoid shrugging your right / left shoulder as your arm rises by keeping your shoulder blade tucked down and toward your mid-back spine. Hold __________ seconds.

  • Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH – Abduction, Supine

  • Stand with good posture. With an underhand grip on your right / left hand and an overhand grip on the opposite hand, grasp a broomstick or cane so that your hands are a little more than shoulder-width apart.

  • Keeping your right / left elbow straight and shoulder muscles relaxed, push the stick with your opposite hand to raise your right / left arm out to the side of your body and then overhead. Raise your arm until you feel a stretch in your right / left shoulder, but before you have increased shoulder pain.

  • Try to avoid shrugging your right / left shoulder as your arm rises, by keeping your shoulder blade tucked down and toward your mid-back spine. Hold for __________ seconds.

  • Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image ROM – Flexion, Active-Assisted

  • Lie on your back. You may bend your knees for comfort.

  • Grasp a broomstick or cane so your hands are about shoulder width apart. Your right / left hand should grip the end of the stick so that your hand is positioned "thumbs-up," as if you were about to shake hands.

  • Using your healthy arm to lead, raise your right / left arm overhead until you feel a gentle stretch in your shoulder. Hold for right / left seconds.

  • Use the stick to assist in returning your right / left arm to its starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH – Flexion, Standing

  • Stand facing a wall. Walk your right / left fingers up the wall until you feel a moderate stretch in your shoulder. As your hand gets higher, you may need to step closer to the wall or use a door frame to walk through.

  • Try to avoid shrugging your right / left shoulder as your arm rises, by keeping your shoulder blade tucked down and toward your mid-back spine.

  • Hold for __________ seconds. Use your other hand, if needed, to ease out of the stretch and return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image ROM - Internal Rotation

  • Using underhand grips, grasp a stick behind your back with both hands.

  • While standing upright with good posture, slide the stick up your back until you feel a mild stretch in the front of your shoulder.

  • Hold for __________ seconds. Slowly return to your starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH - Internal Rotation

  • Place your right / left hand behind your back, palm-up.

  • Throw a towel or belt over your opposite shoulder. Grasp the towel with your right / left hand.

  • While keeping an upright posture, gently pull up on the towel until you feel a stretch in the front of your right / left shoulder.

  • Avoid shrugging your right / left shoulder as your arm rises, by keeping your shoulder blade tucked down and toward your mid-back spine.

  • Hold for __________ seconds. Release the stretch by lowering your opposite hand.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH – Elbow Flexors

  • Lie on a firm bed or countertop on your back. Be sure that you are in a comfortable position which will allow you to relax your arm muscles.

  • Place a folded towel under your right / left upper arm, so that your elbow and shoulder are at the same height. Extend your arm; your elbow should not rest on the bed or towel.

  • Allow the weight of your hand to straighten your elbow. Keep your arm and chest muscles relaxed. Your caregiver may ask you to increase the intensity of your stretch by adding a small wrist or hand weight.

  • Hold for __________ seconds. You should feel a stretch on the inside of your elbow. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTHENING EXERCISES - Biceps Tendon Disruption (Proximal)

These exercises may help you regain your strength after your physician has discontinued your restraint in a cast or brace. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Progress the resistance and repetitions only as guided.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does get worse, stop and make sure you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your clinician.

ExitCare Image STRENGTH - Elbow Flexors, Isometric

  • Stand or sit upright on a firm surface. Place your right / left arm so that your hand is palm-up and at the height of your waist.

  • Place your opposite hand on top of your forearm. Gently push down as your right / left arm resists. Push as hard as you can with both arms, without causing any pain or movement at your right / left elbow. Hold this stationary position for __________ seconds.

  • Gradually release the tension in both arms. Allow your muscles to relax completely before repeating.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Shoulder Flexion, Isometric

  • With good posture and facing a wall, stand or sit about 4-6 inches away.

  • Keeping your right / left elbow straight, gently press the top of your fist into the wall. Increase the pressure gradually until you are pressing as hard as you can without shrugging your shoulder or increasing any shoulder discomfort.

  • Hold for __________ seconds.

  • Release the tension slowly. Relax your shoulder muscles completely before you the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – Elbow Flexors, Supinated

  • With good posture, stand or sit on a firm chair without armrests. Allow your right / left arm to rest at your side with your palm facing forward.

  • Holding a __________weight or gripping a rubber exercise band or tubing, bring your hand toward your shoulder.

  • Allow your muscles to control the resistance as your hand returns to your side.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – Elbow Flexors, Neutral

  • With good posture, stand or sit on a firm chair without armrests. Allow your right / left arm to rest at your side with your thumb facing forward.

  • Holding a __________ weight or gripping a rubber exercise band or tubing, bring your hand toward your shoulder.

  • Allow your muscles to control the resistance as your hand returns to your side.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Shoulder Flexion

  • Stand or sit with good posture. Grasp a __________ weight, or an exercise band or tubing, so that your hand is "thumbs-up," like when you shake hands.

  • Slowly lift your right / left arm as far as you can without increasing any shoulder pain. Initially, many people can only raise their hand to shoulder height.

  • Avoid shrugging your right / left shoulder as your arm rises, by keeping your shoulder blade tucked down and toward your mid-back spine.

  • Hold for __________ seconds. Control the descent of your hand as you slowly return to your starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – Forearm Supinators

  • Sit with your right / left forearm supported on a table, keeping your elbow below shoulder height. Rest your hand over the edge, palm down.

  • Gently grip a hammer or a soup ladle.

  • Without moving your elbow, slowly turn your palm and hand upward to a "thumbs-up" position.

  • Hold this position for __________ seconds. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – Forearm Pronators

  • Sit with your right / left forearm supported on a table, keeping your elbow below shoulder height. Rest your hand over the edge, palm up.

  • Gently grip a hammer or a soup ladle.

  • Without moving your elbow, slowly turn your palm and hand upward to a "thumbs-up" position.

  • Hold this position for __________ seconds. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.