SHOULDER & UPPER ARM INJURIES - Tear of the Long Tendon of the Biceps
The biceps muscle is located in the front of your upper arm. It helps you to bend your arm at the elbow and also to rotate your arm. It’s other function is to stabilise the shoulder.
Tendons are used to attach muscles to the bone. The biceps tendon attaches the biceps muscle to the bones in the shoulder and in the elbow. The upper end of the biceps muscle has 2 tendons (Long Head, and Short Head) that attach to bones in the shoulder. The long head attaches to the top of the shoulder socket (Glenoid). The short head attaches to the shoulder blade (Coracoid Process).
1) ulna
2) humerus
3) radius
4) biceps brachii tendon
5) short head of biceps tendon
6) scapula
7) coracoid process
8) acromion process
9) biceps brachii
10) long head of biceps tendon

Biceps Tendon tears can be either partial or complete. I find that torn tendons normally begin as a fraying of the tendon. The damage gets worse and the tendon can completely tear, sometimes by lifting a heavy object. Normally it is the Long /Tendon of the Biceps that is injured, because it is more vulnerable as it runs through the shoulder joint to attach into the socket. Because the Biceps has 2 attachments at the shoulder, the short head rarely tears, so people can still use their biceps if the long head does completely tear.
Causes
There are 2 main causes of Biceps Tendon tears, injury and overuse.
Injury - Falling hard on an outstretched arm, or lifting something that is too heavy, could cause a tear in your Biceps Tendon.
Overuse - Alot of tears are due to wear and tear and fraying of the tendon. This fraying will happen slowly over time, especially as we get older. It gets worse with overuse, which in this case, is a constant shoulder movement again and again. Overuse can cause different shoulder problems, e.g. rotator cuff injuries, shoulder impingement and tendonitis. This will put more stress and strain on the Biceps Tendon, which will weaken or even tear it.
Other factors to take in to account for tendon tears are 1) Age. The older we get the more wear and tear we will have on the tendon than in younger people. 2) Heavy Overhead Activities. Tears are seen in gymnasts, tennis players, badminton players, wrestlers, rowers, javelin throwers and especially weightlifters. Too much loading on weightlifting is a typical example of this risk. Many jobs also require heavy overhead lifting which puts wear and tear on the tendons. 3) Smoking. Using nicotine can affect nutrition in the tendons. 4) Corticosteroid Injections. This type of medication has been shown to increase muscle and tendon weakness.
Symptoms
1) There is a sudden sharp pain in the upper arm and anterior (front) of the shoulder. 2) You sometimes will get a popping or snapping sound. 3) Swelling can be seen over the front part of the upper arm. 4) The biceps muscle will cramp with hard use of the arm. 5) Could sometimes see bruising from the middle of the upper arm to the elbow. 6) In early stages you will not be able to contract the muscle against a resistance. 7) Strength will be effected when the elbow joint is flexed and the forearm is twisted, hand palm up. 8) A slow contraction of the biceps will show a more prominent swelling than that of the normal biceps of the healthy arm. The muscle will not be able to flex the elbow jointfully.
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Treatment
My initial treatment would be Ice treatment, 15-20 minutes a time, at least 3 times a day, for a few days. Ice packs can be purchased from our Online Sports Shop, Serious About Sport. Do not apply ice directly to the skin.
Rest as much as possible, and certainly avoid heavy lifting and overhead activities. This will relieve pain and limit swelling. Using a sling may be recommended for a short time.
I would advise flexibility and strength exercises and design and monitor a rehabilitation programme appropriate to the injury and the patients sport.
The doctor may prescribe nonsteroidal anti-inflammatory medications like ibuprofen, aspirin or naproxen to reduce pain and swelling.
Healing
If surgery is not needed, then strength and mobility exercises can start as soon as the pain begins to go away. After some treatment there may be some weakness.
If surgery is carried out, R.O.M. (range of motion) exercises can start within 1-2 weeks. Conditioning exercises that do not include the upper arm, can start early. You can gradually increase the strength training a few weeks later. Any contact sports should be avoided for at least 2-3 months.







































