PROXIMAL BICEPS RUPTURE
Its description, causes, symptoms, diagnosis and treatment (operative and non-operative)
The biceps muscle has two origin points around the shoulder: the long head starts on the glenoid and the short head on the coracoid. The long head is more commonly injured/inflamed as it exits the “ball and socket” joint near the rotator cuff in the front of the shoulder. Proximal biceps rupture is spontaneous tearing of the long head of the biceps from its origin on the glenoid.
What are the causes?
Proximal biceps rupture typically occurs with trauma, falls or sudden lifting. The tendon may be predisposed to rupture if it is chronically inflamed (tendinitis) or with an associated rotator cuff tear.
What are the symptoms?
Proximal biceps tendon rupture causes immediate pain, swelling and bruising in the front of the shoulder. With time, bruising travels down the front of the arm towards the muscle. Simultaneously, a bulge in the front of the arm appears and the muscle contracts. This is known as a “Popeye” deformity. Muscle spasm and weakness with flexing the elbow and rotating the wrist may be noticed with proximal biceps rupture.
How is it diagnosed?
Your surgeon will perform a thorough history and physical exam with X-rays. The shoulder will be moved through a range of motion and stressed in certain ways to elicit pain or feelings of laxity. X-rays may or may not show damage to the bones of the GH joint, particularly after an acute injury or dislocation. MRI (with contrast dye) is helpful for evaluating the labrum, biceps and rotator cuff for damage.
How is it treated?
Non-operative - Non-operative treatment of proximal biceps rupture is common. Physical therapy, anti-inflammatory medication, cryotherapy and activity modification early after the injury help reduce pain, inflammation and muscle spasm. Over time, patients may have significant pain relief if they suffered from chronic biceps tendinitis prior to the injury. Most patients will not see a significant decrease in elbow or wrist function since the short head of the biceps is still intact. The “Popeye” deformity is permanent but the cosmetic deformity has no effect on overall function.
Operative - Surgical intervention for proximal biceps rupture is limited to athletes, particularly overhead athletes, patients with manual labor occupations that include repetitive elbow and wrist motion (electricians, carpenters, etc.) as fatigue and muscle spasm may occur and patients that do not want the “Popeye” deformity. In these cases, your surgeon will perform a biceps tenodesis, reattaching the tendon to a site along the arm bone. The reattachment is not performed at the site of injury at the tendon origin.