What You Need to Know About Torn Bicep Tendon Injuries

Your bicep is the muscle in the front of your upper arm. It helps you bend your elbow and twist your forearm.

Three tendons attach your bicep to bone:

  • The long head tendon attaches your bicep to the top of your shoulder socket.
  • The short head tendon attaches your bicep to a bump on your shoulder blade called the coracoid process.
  • A third tendon attaches your bicep to your radius, which is one of the bones in your forearms.

When you have a torn bicep, one of these tendons is damaged or detaches from the bone. Any of these three bicep tendons can tear.

Types of bicep tendon tear injuries

There are three types of bicep tendon tear injuries, categorized by their location and severity. Tears can also be partial (in which a tendon is damaged) or complete (in which the tendon completely detaches from the bone).

The three types of bicep tendon tear injuries are:

Proximal biceps tendon tear at shoulder

This injury occurs when one of the tendons that attaches the bicep to the shoulder tears. The long head tendon is more likely to tear than the short head tendon. This type of tear often starts as normal tendon fraying, but can also tear if you get injured.

It’s likely that only one part of the tendon will tear in this injury. This means that you can usually continue to use your arm. However, a bicep tendon tear at the shoulder may damage other parts of the shoulder at the same time.

Distal biceps tendonitis and tear at the elbow

A bicep tendon tear at the elbow usually happens when the elbow is pushed straight against a heavy weight. This stress can tear the tendon from the bone, and usually causes a complete tear.

When you tear your bicep tendon at the elbow, your other arm muscles will compensate, so you’ll still have full range of motion. However, your arm will most likely lose strength if the tendon is not repaired. Bicep tendon tears at the elbow are not common. They happen to approximately 3 to 5 people per 100,000 per year. They’re also less common in women. Distal biceps tendonitis is inflammation in the biceps tendon near the elbow. It’s usually caused by normal wear and tear but repetitive motion can make it worse.

Tendonitis (microtears from use)

Tendonitis is the inflammation or irritation of the long head of the bicep tendon. This can cause microtears. As with distal biceps tendonitis, tendonitis of the long head of the biceps tendon is usually due to normal wear and tear, but can also be made worse by repetitive motion. It often happens with other shoulder problems, such as arthritisshoulder impingement, and chronic shoulder dislocation.

Torn bicep tendon symptoms

Symptoms of a torn bicep tendon include:

  • a “pop” or tearing sensation when the injury happens
  • warmth around the injury
  • swelling
  • bruising
  • pain or ache at the injury site, and throughout your arm (usually severe at first, and may get better over a few weeks)
  • arm weakness
  • difficulty turning your palm
  • fatigue or increased pain in your arm when you do repetitive activity
  • bulge in your upper arm, because the bicep is no longer being held in place (you might also see a gap or indentation in front of your elbow)

Causes of a torn bicep tendon

The two main causes of a torn bicep tendon are injury and overuse. Injuries might be caused by lifting something heavy or falling on your arm. Most tears of the elbow bicep tendon happen because of an injury.

Overuse can cause the tendons to wear down or fray over time. This happens naturally as you age. It may also be made worse by repetitive motion, and is common in people who participate in sports such as weightlifting, tennis, or swimming.

Diagnosing a torn bicep tendon

To diagnose a torn bicep tendon, a doctor will first take a medical history. They’ll ask about your symptoms, whether you had any recent injuries, and when the pain began.

Then they’ll do a physical exam to test your range of motion and strength. During these tests, they’ll see if you have pain or difficulty with certain movements, especially rotations. They’ll also look at your arm for swelling, bruising, or bulging.

A history and physical exam are often enough to diagnose a bicep tendon tear. However, your doctor might also do an X-ray to help rule out any bone injuries, or an MRI to see if the tear is partial or complete.

Torn bicep treatment

Treatment for a torn bicep will mostly depend on how severe the tear is, as well as your overall bicep function and whether you damaged any other body part, such as your rotator cuff. Potential treatments include:

Rest

Taking time off from exercising, lifting, or holding anything heavy — and using your arm as little as possible — can help you recover, especially from overuse injuries. Be sure to avoid any activity that causes pain, even if it doesn’t seem strenuous.

NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are over-the-counter medications that help reduce inflammation. They can help reduce the inflammation (the hallmark of tendonitis), as well as help reduce swelling from bicep tears. They can also help reduce the pain you might have from any bicep tendon injuries.

Physical therapy

Physical therapy can help you regain strength and range of motion after a bicep tendon injury. A physical therapist will take you through a series of motions designed to help heal your injury and relieve pain.

A physical therapist or your doctor might also give you exercises to do at home when you’re healed enough to do so. These might include exercises to flex and extend your arm, arm rotations, and strength-building exercises like bicep curls.

Torn bicep surgery

If none of the measures above help your bicep injury heal, or if more than half the tendon is torn, your doctor might recommend surgery to repair the bicep tendon.

Many doctors will recommend surgery as a first-line treatment for bicep tendon tears at the elbow, although surgery can also be done later if other treatments don’t restore range of motion and strength.

Surgery is used to reattach the tendon to the bone. Complications of surgery are rare, but may include arm numbness or weakness. In some people, the tendon can tear again.

Torn bicep tendon recovery time

Recovery time depends on the severity of the bicep tendon tear, as well as type of treatment. Even mild injuries can take at least two months to heal. It often takes four to five months before you can start returning to normal activities.

After surgery, you’ll probably need to wear a sling or otherwise immobilize your arm such as in a splint or cast for four to six weeks. You’ll then have to do physical therapy and exercises to help strengthen your arm and improve range of motion.

Complete recovery from surgery can take up to a year, although most people recover much of their range of motion and strength in four to six months.

Takeaway

Bicep tendon tears can be serious, but many respond to nonsurgical treatment, such as rest and physical therapy. If you think you might have injured your bicep tendon, see a doctor as soon as possible. Getting a diagnosis and treatment early can help you recover more fully.


New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Adult Forearm Fractures

Adult Forearm Fractures

Article Featured on AAOS

Your forearm is made up of two bones, the radius and ulna. In most cases of adult forearm fractures, both bones are broken.

Fractures of the forearm can occur near the wrist at the farthest (distal) end of the bone, in the middle of the forearm, or near the elbow at the top (proximal) end of the bone. This article focuses on fractures that occur in the middle segments of the radius and ulna. Fractures that involve the wrist or the elbow are discussed in separate articles.

Anatomy

If you hold your arms at your side with your palms facing up, the ulna is the bone closest to your body and the radius is closest to your thumb. The ulna is larger at the elbow — it forms the “point” of your elbow — and the radius is larger at the wrist.

The primary motion of the forearm is rotation: the ability to turn our palms up or down. The ulna stays still while the radius rotates around it. This is the motion used to turn a screwdriver or twist in a light bulb. Forearm fractures can affect your ability to rotate your arm, as well as bend and straighten the wrist and elbow.

Description

Forearm bones can break in several ways. The bone can crack just slightly, or can break into many pieces. The broken pieces of bone may line up straight or may be far out of place.

Fractures of both the radius and ulna.

Fractures of both the radius and ulna.

In some cases, the bone will break in such a way that bone fragments stick out through the skin or a wound penetrates down to the broken bone. This is called an open fracture and requires immediate medical attention because of the risk for infection.

Because of the strong force required to break the radius or ulna in the middle of the bone, it is more common for adults to break both bones during a forearm injury. When only one bone in the forearm is broken, it is typically the ulna — usually as a result of a direct blow to the outside of your arm when you have it raised in self defense.

Cause

The most common causes of forearm fractures include:

  • Direct blow
  • Fall on an outstretched arm, often during sports or from a height
  • Automobile/motorcycle accidents

Symptoms

A broken forearm usually causes immediate pain. Because both bones are usually involved, forearm fractures often cause an obvious deformity — your forearm may appear bent and shorter than your other arm. You will most likely need to support your injured arm with your other hand.

Additional symptoms include:

  • Swelling
  • Bruising (not as common as in other broken bones)
  • Inability to rotate arm
  • Numbness or weakness in the fingers or wrist (rare)

Doctor Examination

Most people with forearm fractures will go to an urgent care center or emergency room for initial treatment.

Physical Examination and Medical History

It is important that your doctor knows the circumstances of your injury. For example, if you fell from a ladder, how far did you fall? It is just as important for your doctor to know if you sustained any other injuries and if you have any other medical problems, such as diabetes. Your doctor also needs to know if you take any medications.

After discussing your symptoms and medical history, your doctor will do a careful examination. Your doctor will:

  • Examine your skin to see if there are any cuts from the injury. Bone fragments can break through the skin and create lacerations. This leads to an increased risk for infection.
  • Palpate (feel) all around your arm to determine if there are any other areas of tenderness. This can indicate other broken bones or injuries.
  • Check your pulse at the wrist to be sure that good blood flow is getting through your forearm to your hand.
  • Check to see if you can move your fingers and wrist, and can feel things with your fingers. Sometimes, nerves may be injured at the same time that the bone is broken, which can result in hand and wrist weakness and numbness.
  • The doctor may examine your shoulder, upper arm, elbow, wrist, and hand, even if you only complain of arm pain.

X-rays

X-rays are the most common and widely available diagnostic imaging technique. X-rays can show if the bone is broken and whether there is displacement (the gap between broken bones). They can also show how many pieces of broken bone there are.

Treatment

Treatment of broken bones follows one basic rule: the broken pieces must be put back into position and prevented from moving out of place until they are healed. Because the radius and ulna rely on each other for support, it is important that they are properly stabilized. If the bones are not accurately aligned during healing, it may result in future problems with wrist and elbow movement.

Most cases of adult forearm fractures require surgery to make sure the bones are stabilized and lined up for successful healing.

Immediate Treatment

While you are in the emergency room, the doctor may try to temporarily realign the bones, depending upon how far out of place the pieces are. “Reduction” is the technical term for this process in which the doctor moves the pieces into place. This is not a surgical procedure. Your pain will be controlled with medication. Afterward, your doctor will apply a splint (like a cast) to your forearm and provide a sling to keep your arm in position. Unlike a full cast, a splint can be tightened or loosened, and allows swelling to occur safely.

forearm fracture splint application

The emergency room doctor may apply a splint to protect your arm.

Reproduced with permission from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

It is very important to control the movement of a broken bone. Moving a broken bone can cause additional damage to the bone, nearby blood vessels, and nerves or other tissues surrounding the bone.

Additional immediate treatment will include applying ice to help reduce swelling, and providing you with pain medicine.

Nonsurgical Treatment

If only one bone is broken and it is not out of place, it may be possible to treat it with a cast or brace. Your doctor will closely monitor the healing of the fracture, and have you return to the clinic for x-rays frequently. If the fracture shifts in position, you may require surgery to put the bones back together.

Surgical Treatment

When both forearm bones are broken, or if the bones have punctured the skin (open fracture), surgery is usually required.

Because of the increased risk for infection, open fractures are usually scheduled for surgery immediately. Patients are typically given antibiotics by vein (intravenous) in the emergency room, and may receive a tetanus shot. During surgery, the cuts from the injury will be thoroughly cleaned out. The broken bones are typically fixed during the same surgery.

If the skin around your fracture has not been broken, your doctor may recommend waiting until swelling has gone down before having surgery. Keeping your arm immobilized and elevated for several days will decrease swelling. It also gives skin that has been stretched a chance to recover.

Open reduction and internal fixation with plates and screws. This is the most common type of surgical repair for forearm fractures. During this type of procedure, the bone fragments are first repositioned (reduced) into their normal alignment. They are held together with special screws and metal plates attached to the outer surface of the bone.

forearm fracture fixation with plates and screws

The broken bones of the forearm are held in position by plates and screws while they heal.

Open reduction and internal fixation with rods. During this procedure, a specially designed metal rod is inserted through the marrow space in the center of the bone.

External fixation. If the skin and bone are severely damaged, using plates and screws and large incisions may injure the skin further. This may result in infection. In this case, you may be treated with an external fixator. In this type of operation, metal pins or screws are placed into the bone above and below the fracture site. The pins and screws are attached to a bar outside the skin. This device is a stabilizing frame that holds the bones in the proper position so they can heal.

Complications

Complications from Forearm Fractures

Forearm fractures can cause further injury and complications.

  • The ends of broken bones are often sharp and can cut or tear surrounding blood vessels or nerves.
  • Excessive bleeding and swelling right after the injury may lead to acute compartment syndrome, a condition in which the swelling cuts off blood supply to the hand and forearm. It typically occurs within 24 to 48 hours of the injury and causes severe pain when moving the fingers. Compartment syndrome can result in loss of sensation and function, and requires emergency surgery once it is diagnosed. In such cases, the skin and muscle coverings are opened and left open to relieve pressure and allow blood to return.
  • Open fractures expose the bone to the outside environment. Even with good surgical cleaning of the bone and muscle, the bone can become infected. Bone infection is difficult to treat and often requires multiple surgeries and long-term antibiotics.

Complications from Surgery

There are risks associated with all surgery. If your doctor recommends surgery, he or she thinks that the possible benefits of surgery outweigh the risks.

  • Infection. There is a risk of infection with any surgery, whether it is for a forearm fracture or another purpose.
  • Damage to nerves and blood vessels. There is a minor risk of injury to nerves and blood vessels around the forearm. Although some temporary numbness is common right after your injury, if you experience persistent numbness or tingling in your fingers, contact your doctor.
  • Synostosis. Another rare complication is healing between the two bones of the forearm with a bridge of bone known as synostosis. This can decrease the rotation of the bones and prevent full movement.
  • Nonunion. Surgery does not guarantee healing of the fracture. A fracture may pull apart, or the screws, plates, or rods may shift or break. This can occur for a variety of reasons, including:
    • The patient does not follow directions after surgery.
    • The patient has other health issues that slow healing. Some diseases, like diabetes, slow healing. Smoking or using other tobacco products also slow healing.
    • If the fracture was associated with a cut in the skin (an open fracture), healing is often slower.
    • Infections can also slow or prevent healing.

If the fracture fails to heal, further surgery may be needed.

Recovery

Bones have a remarkable capacity to heal. Forearm bones typically take 3 to 6 months to fully heal. The more severe your injury, however, the longer your recovery may be.

Pain Management

Pain after an injury or surgery is a natural part of the healing process. Your doctor and nurses will work to reduce your pain, which can help you recover faster.

Medications are often prescribed for short-term pain relief after surgery or an injury. Many types of medicines are available to help manage pain, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids.

Be aware that although opioids help relieve pain after surgery or an injury, they are a narcotic and can be addictive.  It is important to use opioids only as directed by your doctor. As soon as your pain begins to improve, stop taking opioids. Talk to your doctor if your pain has not begun to improve within a few days of your treatment.

Rehabilitation

Nonsurgical treatment. Rehabilitation typically begins after a few weeks of keeping the arm still by using a cast or brace. In many cases, a physical therapist will help with rehabilitation, beginning with gentle exercises to increase range of motion, and gradually adding exercises to strengthen the arm.

Surgical treatment. Depending on the complexity of the fracture and the stability of the repair, a cast or brace may be necessary for 2 to 6 weeks after surgery. Motion exercises for the forearm, elbow, and wrist usually begin shortly after surgery. This early motion is important to prevent stiffness. Your doctor may also prescribe visits to a physical or occupational therapist, depending on how long your arm was immobilized.

Outcome

Some stiffness after healing is common, but this does not usually affect the overall function of your arm.

Your doctor will advise you on when you may return to work and sports activities. This varies depending on the fracture pattern and the type and stability of the repair.

If you have had surgery, the plates and screws are usually left in place forever. If you consider removal, this second surgery is typically not scheduled until your bones have fully solidified (1 to 2 years after initial surgery)