Ask Dr. Hildahl: Treatment Options for Biceps Injuries
Learn about the conservative and surgical treatments for biceps injuries.
Popeye would be the first to tell you that bulging biceps are an iconic symbol of physical strength. But biceps aren’t just about gym cred. These upper arm muscles serve us whether we flex them in a bodybuilder pose, engage them to move heavy furniture, or use them to twist a screwdriver. Consequently, biceps injuries can have a significant impact on quality of life. We spoke with hand and upper extremity surgeon Dr. Blake Hildahl about how injury occurs and about the treatment options available.
The anatomy of the biceps muscle and connecting tendons
“The biceps muscle is an upper arm muscle you commonly see people exercise at the gym,” he says. “Located on the front of the upper arm, it is connected to the shoulder joint by two tendons (called the long head and short head) and at the elbow by a single tendon. These tendons are tough strips of tissue connecting muscle to bone. Thanks to those tendons, we can move our arms. The biceps muscle and connecting tendons function to pull your forearm up and rotate it outward—this is called supination.”
Causes of biceps injuries
Biceps injuries range in severity from tendinitis to a complete tendon tear. Tendinitis, caused by repetitive motion, overuse, or sudden injury, can make tendons sore and painful. If repetitive motion continues without giving the tendon time to recover, fraying of the tendon tissues can occur. Eventually, fraying can result in a complete tendon tear. Sudden injuries like falls or exertion while lifting a heavy object can also cause tears.
Biceps injuries causing tendinitis
“Most tendinitis is caused by overuse,” Dr. Hildahl explains. “For this reason, prevention is the best treatment. Build physical activity slowly and stop when repetitions cause unusual pain.
“When tendinitis does develop, it can usually be completely resolved with conservative treatment. This includes a combination of rest, cold packs to reduce swelling, injections, and nonsteroidal anti-inflammatory medications. And of course, you want to avoid heavy lifting during recuperation. When tendinitis doesn’t respond to these treatments, we may consider surgery to remove inflammatory tissue and repair tears in the tendon.”
Symptoms of a biceps tear
“A certain percentage of the population will partially or completely tear a connective tendon,” says Dr. Hildahl. “Some of these injuries are the result of sudden trauma, like a fall or damage done while trying to lift a heavy object. Others are the result of ongoing overuse that gradually frays and weakens tendon tissues until they tear. Proximal (by the shoulder) biceps tears are more common than distal (by the elbow) tears, but I see both in my clinic. When a biceps tendon tears, you may feel sharp pain at the injured joint, a feeling of weakness, or an audible pop coming from the injured joint. A bruise may appear on the upper arm or on the forearm near the elbow. When the tendon tears completely, the muscle snaps like a rubber band and visibly bunches up in the arm. This is what we call a Popeye muscle.”
Conservative treatment for partially or completely torn biceps
“There are two treatment options for these biceps injuries,” says Dr. Hildahl. “It may surprise people to learn that one option is to do nothing. Because we have a lot of muscles in the upper arm that perform flexing activities, a torn biceps doesn’t necessarily prevent us from using our arm or bringing our hand to our mouth. As a result, living with a torn biceps may be an option for some people.”
However, the biceps is also critical to our ability to turn our wrist. For example, when you turn a screwdriver, you are using your biceps. “The main weakness resulting from a biceps tendon tear affects what we call supination, or turning the wrist,” Dr. Hildahl explains. “So, if you’re a handyman, you probably want to reclaim wrist-turning motion. And that means looking at surgical options.”
Surgical treatment for partially or completely torn biceps
“Partial biceps tendon tears are also called tendonitis and can be very painful at the shoulder and at the elbow,” says Dr. Hildahl. “We start with conservative treatment, which would involve therapy and possible injections. If this does not improve pain, we discuss surgical management. At the proximal end—in the shoulder—we will cut the tendon and reattach it or leave it. You can detach one tendon because you have two ends at the shoulder. If you don’t improve with conservative treatment at the elbow, we then discuss detaching the remaining tendon and debriding the nonviable tissue and reattaching it.
“Complete tears are different,” he continues. “A lot of people with tendonitis in the shoulder go on to a complete tear. This sometimes improves their pain. Usually we do not do surgery on a complete tear in the shoulder. This is because you have another connection by the shoulder that does not tear, so there is limited clinical significance.
“However, when you have a complete tear at the elbow, we talk about surgerical versus nonsurgical managment. You only have one connection at the elbow. If you do nothing, the pain will go away but you will lose about 30 percent of your elbow flexing (bending) strength. You will also lose about 40 percent of your supination strength. Supination is the function that enables you to perform functions like turning the hand up to hold a cup of soup.
“Because complete tears at the elbow have a serious impact on wrist rotation, they are more likely to need surgical repair,” he notes. “It’s also important to make surgical decisions quickly, because scarring of the distal (elbow) tendon and muscle begins within one to two weeks of the tear. If the repair isn’t done quickly, surgery may not be possible.”
There are several different surgical techniques to fix these biceps injuries. “Generally, tendon tear repairs involve locating the retracted tendon in the arm, suturing it, and reconnecting it to the bone, explains Dr. Hildahl. “There are a few different ways to reattach the tendon to the forearm, and all methods have equivalent results in a clinical setting.”
Recuperation following biceps injuries
“Recovery times vary from patient to patient,” notes Dr. Hildahl. “Usually, you want to give yourself three months to recover. At that point, you’ll be recovered and functional, but your arm will still be weak. Getting back to full strength may take up to a year with therapy support.”
Summit Orthopedics provides personalized hand and wrist expertise
The function of our hands is integrated through our wrists and arms to our shoulders; a problem anywhere along our arm may have a significant impact on hand function and quality of life. If you experience an injury or uncomfortable symptoms, our fellowship-trained hand and wrist surgeons are here to help. Summit physicians receive the highest levels of training and exclusively provide individualized care for conditions of the hand, wrist, and elbow.
Summit has convenient locations across the Minneapolis-St. Paul metro area, serving Minnesota and western Wisconsin. We have state-of-the-art centers for comprehensive orthopedic care in Eagan, MN, Vadnais Heights, MN, and Woodbury, MN, as well as additional community clinics throughout the metro and southern Minnesota.
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