How to Manage a Biceps Tendon Rupture: Expert Advice Needed

Q: How to Manage a Biceps Tendon Rupture: Expert Advice Needed

Hello： In response to your inquiry regarding the biceps, there are two tendon attachment points at the shoulder： one is the long head tendon, which attaches to the superior margin of the glenoid, and the other is the short head tendon, which attaches to the coracoid process. <br>

How to manage a biceps tendon rupture?

Hello Dr.
Li: I have a job that requires heavy lifting every day.
Last week, I accidentally injured my left shoulder due to improper posture and force, resulting in a rupture of the biceps tendon.
I have seen another doctor who informed me that if I do not undergo surgery, my strength will decrease by 20% in the future.
I would like to hear your opinion on this matter (today is already the fourth day).
Thank you!

Bu xiu gang, 40~49 year old female. Ask Date: 2002/07/15

Dr. Li Wenlin reply Orthopedics

Hello: In response to your inquiry regarding the biceps, there are two tendon attachment points at the shoulder: one is the long head tendon, which attaches to the superior margin of the glenoid, and the other is the short head tendon, which attaches to the coracoid process.
Commonly, biceps tendon ruptures at the shoulder, particularly in individuals over 50 years old, are primarily associated with issues related to the long head tendon.
Given the necessity of daily activities, surgical intervention combined with rehabilitation therapy is the most effective treatment for restoring function, and it is best to perform the surgery as soon as possible for optimal results (ideally within seven to ten days).
Additionally, it is worth noting that a rupture of the long head biceps tendon at the shoulder often coexists with issues related to the rotator cuff.
If preoperative ultrasound or MRI can be performed, having accurate information beforehand will enhance the surgical outcome.
Furthermore, comprehensive postoperative rehabilitation is crucial.
I recommend that you seek medical attention promptly for surgery and not delay any further.
Wishing you a speedy recovery.

Reply Date: 2002/07/15

More Info

Managing a biceps tendon rupture, particularly for someone who engages in heavy lifting and physical labor, requires careful consideration of both surgical and non-surgical options. The biceps tendon can rupture at two primary locations: at the shoulder (proximal biceps tendon rupture) or at the elbow (distal biceps tendon rupture). Given your description, it seems you may be dealing with a proximal rupture, which is more common.

Understanding the Injury
A biceps tendon rupture can lead to significant pain, weakness, and a loss of function in the affected arm. The biceps muscle plays a crucial role in elbow flexion and forearm supination (turning the palm up). When the tendon is ruptured, you may experience a noticeable deformity, often described as a "Popeye" muscle, where the muscle belly bulges due to the retraction of the tendon.

Non-Surgical Management
If you opt for non-surgical management, it typically involves:
1. Rest and Activity Modification: Avoid activities that exacerbate the pain or put stress on the shoulder. This includes heavy lifting and overhead movements.

2. Physical Therapy: Engaging in a structured rehabilitation program can help restore strength and range of motion. A physical therapist can guide you through exercises tailored to your recovery.

3. Pain Management: Over-the-counter pain relievers such as NSAIDs (e.g., ibuprofen or naproxen) can help manage pain and inflammation.

4. Bracing or Sling: In some cases, using a sling or brace may provide additional support during the initial healing phase.

Surgical Management
If you are considering surgery, it is essential to discuss the potential benefits and risks with your orthopedic surgeon. Surgical options typically involve reattaching the tendon to the bone, which can restore function and strength more effectively than non-surgical methods, especially for individuals who rely on their upper body strength for work.

1. Timing: Surgery is generally most effective when performed within a few weeks of the injury. Delaying surgery may lead to complications or a less favorable outcome.

2. Rehabilitation Post-Surgery: Post-operative rehabilitation is crucial. You will likely start with passive range-of-motion exercises before progressing to strengthening exercises as healing allows.

3. Expected Outcomes: While surgery can restore function, some studies suggest that even with surgery, patients may experience a reduction in strength compared to their pre-injury levels. However, many individuals can return to their previous level of activity.

Considerations for Heavy Lifting
Given your occupation, it is vital to consider how this injury may affect your work. If you choose non-surgical management, be prepared for a potential decrease in strength, as indicated by the doctor you consulted. If you opt for surgery, follow the rehabilitation protocol closely to maximize your recovery.

Conclusion
Ultimately, the decision between surgical and non-surgical management should be based on your specific circumstances, including your activity level, the severity of the rupture, and your personal goals for recovery. Consulting with an orthopedic specialist who understands your lifestyle and work demands will provide the best guidance. They can help you weigh the risks and benefits of each approach, ensuring that you make an informed decision that aligns with your needs.

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