The muscle at the front of the upper arm is called the biceps (also called musculus biceps brachii). It is a muscle that has its course from the shoulder region to the forearm region and is responsible for bending the elbow (flexion), turning the forearm outward (supination), lifting the arm forward (anteflexion) and a slightly supportive function in moving the arm sideways (abduction).
Tearing of the biceps tendon usually occurs while the biceps is subjected to too much sudden force, often during sports with maximum strength exertion. A biceps tendon tear can also occur from gradual overuse of the muscle. This is because repeated use can reduce the load capacity of the muscle. In this form, we more often see that the attachment at the bottom is involved.
Tearing of the biceps tendon is frequently seen in men over the age of 50. In general, the cause lies largely in a piece of aging tendon. The biceps tendon has a less favorable position in the shoulder and is therefore more susceptible to injury.
Because of the small space between the shoulder head (over which the biceps tendon runs) and the shoulder roof, the biceps is subject to compression, resulting in minor damage in the long run. Other factors that contribute to tearing the biceps tendon are smoking and the use of corticosteroids (anti-inflammatory medication).
Tearing of the biceps tendon is often accompanied by an audible snap and considerable sharp pain. Physically, the immediate result is that the bending strength decreases and that, when the elbow is bent, a clear bulge of the bicep can be seen (the popeye phenomenon). Swelling can also be present and blue discoloration can be seen. It is a symptom with a fairly typical occurrence. Because of this, the physiotherapist will be able to diagnose a biceps tendon rupture during the intake interview and accompanying examination.
A completely torn tendon does not grow back on its own. Despite this, the recovery prognosis for a biceps tendon rupture is fortunately good. With the help of physical therapy you are generally able to perform your daily activities again in a relatively short period of time. A small strength difference between the left and right arm may remain. In other cases, surgery is performed. This is done for people who have to strain the arm daily, for example for work or (power) sports. Surgery is also performed when the lower part of the biceps (distal) is torn off. If someone is eligible, the goal is to perform the surgery as soon as possible, preferably within 2 to 3 weeks at most. This is because the tendon can begin to retract and scar tissue can form fairly quickly. These factors make the surgery more difficult.
Rehabilitation after surgery takes time. The first four weeks you will start wearing a sling. In time, a brace can be added to guarantee that the biceps tendon does not get too much tension/stretch in the first weeks of the healing process. Rehabilitation is built up slowly with attention to increasing mobility and load capacity. Most patients are able to return to all normal activities about 20 weeks after surgery. Virtually everyone who undergoes this surgery regains full mobility and load capacity of the arm over time.