Your Biceps is a prominent muscle on the front of your upper arm.
It is attached to your shoulder blade (scapula) and to your radius (one of your bones in your forearm). The main function of the biceps is to rotate your forearm and bend your elbow.
A Distal tear means that your biceps has been torn (either completely or only partly) from its attachment to the radius (near the elbow). Tears of the distal biceps tendon usually affect men who are older than 40 years of age, but may also occur in athletes.
If you have a tear of your biceps tendon, it can lead to weakening of your ability to bend your elbow and rotate your forearm inwards.
Depending on the severity of the tear, the biceps can either be repaired through surgery or through intensive physiotherapy. The decision of one over the other will vary depending on how much strength and function is needed in that arm.
Symptoms
At the time of injury, a loud ‘popping’ sound may be heard, followed by severe pain at the affected elbow. Pain may subside after a week or two.
There may also be:
- Bruising and swelling at the elbow
- A large bulge near the shoulder (This is referred to as the “Popeye sign” after the muscled cartoon character. The bulge is actually the contracted biceps muscle).
- Weakness in bending the elbow.
Causes
The main cause of a biceps tear at the elbow is a sudden injury. The most common situation in which the tendon is torn is when the elbow suddenly straightens under the strain of a heavy load. This might occur when picking up a large box, or dumbbells that are too heavy.
Risk Factors
Distal biceps tendon tears are more likely to occur in:
- Males, especially aged 40 or older
- People who smoke
- People who are taking cortisone
Investigations
An X-ray may be required to make sure there is no associated damage to the bones.
An MRI can also be used to show injury to the soft tissues, including the muscle, tendons and ligaments.
Similarly, an Ultarsound Scan can be used to show partial versus complete tears, and can show how the biceps moves.
Complications
If the tendon tear is repaired with surgery, there can occasionally be some numbness or weakness in the forearm. There is also a small chance of needing additional operations if there is limitation of movement, or re-tearing of the tendon. If the tear is not removed with surgery, it is difficult to restore full arm function. The tear will not heal by itself, and the biceps muscle cannot do its job if its attachment at the elbow is disrupted.
Treatment
When this injury first occurs, the standard first-aid treatment of protect, rest, ice, compression and elevation are useful. Simple over-the-counter pain relief is also very useful.
In the first week following your injury, you may need to keep your elbow immobilised in a splint or brace. Make sure you have a very clear idea of when and how you can start moving your arm.
Physiotherapy
The physiotherapy regime will vary depending on the severity of your injury, but a typical example covers several weeks of progressive strengthening, range of motion and flexibility exercises.
Surgery
In some circumstances, the treatment of choice may be surgery. The tear in the biceps tendon is repaired by stitching the two ends of the tear back together. Sometimes the tear is re-attached directly to a bone in the elbow.
Seeking Advice
The Physiotherapist
The physiotherapist will be able to examine your arm and suggest a diagnosis. They may also be able to provide you with:
- Pain relief
- If this is a partial tear, they can begin therapy
- Discuss whether you should seek a medical opinion
Your Family Doctor (GP)
Your Family Doctor will be able to diagnose and help treat your problem. He or she will be able to
- tell you about your problem
- advise you of the best treatment methods
- prescribe you medications
- and if necessary, refer you to Specialists (Consultants) for further treatment
Prevention
The best way to prevent a distal biceps tendon tear is to be sensible when lifting heavy weights. If you feel like the weight is beyond what you’re capable of lifting, put it back down!
Some other general rules to follow when exercising and working out:
- Don’t suddenly increase the work you’re doing – you expose yourself to all kinds of injury!
- Don’t suddenly return to a previous level if you’ve been functioning at a much lower level – work up gradually
- Seek advice from employees at the gym, and if you’ve had a tear before, seek a physiotherapist or surgeon’s advice before beginning