Located in the front of the upper arm, the bicep is an integral muscle responsible for the flexion of the elbow and the supination of the forearm. However, overworking the muscle can lead to a bicep tear. There are numerous factors that can lead biceps to tear, but fortunately, there are prevention and treatment options for this scenario.
Like most muscles, the most common causes of the biceps to tear are overuse and injury. Preventing this from happening involves maintaining sufficient arm strength and avoiding repetitive strenuous movements that involve the shoulder. Smoking and steroid use can also increase the risks of bicep tears. Most of the time, non-surgical treatment would suffice such as rest, ice, and anti-inflammatory drugs. However, surgery might be required for more severe cases.
Bicep Anatomy
The biceps, or the biceps brachii, is one of four muscles that are located in the upper arm – the other three being the coracobrachialis, brachialis, and triceps brachii.
As the name suggests, the biceps is a two-headed muscle (i.e., the triceps is a three-headed muscle) which means that it is composed of a long head and a short head. While a single muscle, each head has a different origin (point of attachment that does not involve contraction). The long head originates from the supraglenoid tubercle while the short head originates from the coracoid process of the scapula.
Both heads join in the middle of the upper arm before inserting (point of attachment that involves contraction) into the radial tuberosity and bicipital aponeurosis into the deep fascia on the medial part of the forearm.
The two heads also differ in function. While both heads contribute to bending the arm, the long head pulls the arm away from the trunk (abduction) and turns it inwards (inward rotation) and the short head pulls the arm back towards the trunk (adduction).
Connecting the muscle to the skeletal system, the bicep muscle has three tendons: two proximal biceps tendons (one for each head origin) and one distal biceps tendon near the elbow.
Bicep Tear
A bicep tear (also called biceps rupture, biceps tendon tear, biceps tendonitis) is a tear or break in the tendons connected to the biceps. There are numerous symptoms that can indicate a bicep tear such as severe pain, bruising, weakness in the arm, difficulty moving or rotating the forearm, or possibly a bulge in the arm.
There are different ways to categorize bicep tears including the location of the injury and the severity of the tear.
A proximal biceps tendon tear occurs in the shoulder. This type of injury can lead to some loss of strength and some pain during forearm supination. Between the two proximal biceps tendons, the tendon of the long head is more likely to tear than the tendon of the short head due to its longer travel. Because there are two tendons in the shoulder connecting to the biceps, a tear in one of them can still leave the individual with the ability to move their arm.
A distal biceps tendon tear occurs in the elbow. Compared to a proximal biceps tendon tear, a distal biceps tendon tear is uncommon. A 2015 paper published in The American Journal of Sports Medicine estimated that the incidence of a distal biceps tendon tear occurred at a rate of 2.55 per 100,000 patient-years. This type of tear is more serious as the tendon will not grow back and connect to the bone. Movement of the arm is still possible with the other muscles working to compensate, but arm strength and function are severely affected.
Sufficient microtears can also cause tendonitis, also known as tendinitis, which is the inflammation of the tendons. Particularly in the proximal biceps tendon, constant overuse can accumulate microtears which will cause the tendons to fray.
Aside from where the tear occurs, bicep tears can also be categorized depending on the severity of the damage. The scale used for this begins at grade 1 to grade 3.
Grade 1 describes a minor injury, usually as a result of overstretching; This grade of bicep tear does not typically result in loss of mobility and strength. Grade 2 describes a moderate tear; This grade of bicep tear will result in some loss of mobility and strength. Grade 3 describes a complete rupture; This grade of bicep tear will require surgery to repair.
Causes of Bicep Tear
Bicep tears can be attributed to two main causes: overuse and injury. Overuse is often due to excessive resistance training, especially when the individual is overloading. An imbalanced training regimen can also lead to a bicep tear. This occurs when the biceps are trained more than the shoulders.
While overuse and injury are primary causes of bicep tears, studies have shown that there are certain risk factors that can also affect the incidence of bicep tears.
One risk factor of bicep tear is age. A 2000 paper published in the Journal of Shoulder and Elbow Surgery studied 200 patients and found that the average age of patients undergoing biceps tenodesis (surgery to treat injuries to the biceps tendon in the shoulder) was 55 years old.
Another study investigated the trends of distal biceps tendon repair in the United States from 2007 to 2011. The 2016 paper published in the Journal of Shoulder and Elbow Surgery assessed 1,443 patients. Statistical analyses showed that 90% of the patients were men while 72% of the patients were aged from 40 to 59. The study discussed that only 29% of the patients were athletically active or had physically demanding occupations at the time of injury which meant that ruptures were caused by accumulated tendinopathy.
Another risk factor that can also increase an individual’s chance of getting a bicep tear is smoking. In the previously cited 2015 study published in The American Journal of Sports Medicine, it was found that smoking was found to be associated with an increased likelihood of injury. This is supported by other studies that report smoking poses deleterious effects on the musculoskeletal system – increasing the chances of tendonitis in smokers by 1.5 times compared to non-smokers.
How to Prevent Bicep Tear
There are many ways to help prevent bicep tears from occurring. Firstly, it is important to be aware of actions or movements that can possibly damage the biceps. For gym-goers and weightlifters, it is imperative to build up sufficient strength before adding more weights to their exercises.
In the gym, it is imperative to perform exercises with proper form and posture. A trainer or experienced individual should be qualified to assess proper form and posture. Furthermore, sufficient rest periods between sets should be observed.
Athletically active individuals should also practice safety and proper form and posture when training in the gym. When practicing sports, these individuals should be mindful of dives, slides, and tackles as these actions might put too much pressure on outstretched arms. Athletes should also be mindful that overuse in excessive practice with repetitive arm movements (e.g., swimming, tennis, baseball pitching, volleyball, etc.) might lead to a bicep tear.
The middle-aged and elderly should avoid lifting heavy objects, especially lifting them above the level of their shoulders. If possible, smoking should be avoided as well; Age and smoking are both risk factors for bicep tears.
Treatment Options
For most people, the pain from bicep tears will fade over time. Any minimal loss of movement and strength will also be regained. Other methods for helping the healing process include ice application, physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), and rest.
However, critical damage such as excessive or complete ruptures will require surgery. Individuals with pain from a bicep tear that has not been resolved after a long period of nonsurgical treatment options can also consider surgery.
The typical procedure used is a tenodesis, which is a minimally invasive procedure that aims to reconnect the tendon back to the bone. With physical therapy, it would take about three months for an individual to completely heal after tenodesis.
