Injury to the biceps is common and uncomfortable arm injury.
There are varying degrees of injury to the biceps. A grade 1 injury is used to describe overstretching the muscle or causing microtears in the muscle. Grade 2 injuries include partial tears of the muscle. Lastly, grade 3 being, complete rupture of the tendon.
Approximately 3 % of biceps tears occur at the distal aspect of the tendon, i.e, the lower end of the muscle belly. A complete rupture is a rare occurrence.
The signs and symptoms
- Pain is the first indicator that something sinister is going on. While it is common to experience a degree of delayed onset muscle soreness following exercise, sharp pain, accompanied by swelling or bruising could indicate a sprained biceps muscle. Pain may be worse with contraction or stretching the muscle.
- As mentioned previously, swelling or bruising may be present following a moderate or severe injury. Inflammation is a sign that your body is repairing itself, while bruising occurs following damage to blood vessels. Bear in mind however, that taking drugs such as asprin can worsen bruising due it the blood thinning properties of the drug.
- In rare cases, the rupture of the tendon causes the remaining end of the tendon to bulge distally (closer the elbow).
- Chronic biceps injuries may present with less obvious symptoms such as non-descript shoulder pain, pain with lifting or overhead activities.
- In the some cases, predominantly in the younger population, the rupture occurs following an explosive movement (involving sudden contraction followed by a stretch to the muscle).
- In the older population, a rupture can occur following chronic impingement or inflammation of the tendon at its origin. Repetitive impingement can lead to minor tears and fraying of the tendon predisposing it to rupture.
- Distal ruptures can occur due to chronic inflammation at the elbow, for example in conditions such as cubital bursitis and rheumatoid arthritis.
- The diagnosis of a biceps tear can only be made following a subjective history and a series of objective tests. If your health professional suspects a moderate to severe biceps tear, they may refer you for further radiological imaging.
- The most common form of imaging for biceps injuries is ultrasonography. This mode of imaging is preferred to the more invasive arthrogram.
There is a great deal of controversy with regards to the optimal treatment of a biceps injury. Surgery is only recommended if the benefits outweigh the risks. The patient’s age, severity of the condition (including cosmetic concerns) medical history, occupation and sporting levels are all taken into account in this process.
In most less severe cases, conservative management is adequate and recommended. This usually includes avoiding aggravating activities, swelling management and physiotherapy. The focus is to maximize function and return to work/ sport when healing has occurred. While tendon healing can be a slow process, ensuring that the muscle is exercised regularly, within pain free limits (as guided by your physiotherapist) can help to promote healing. With the correct treatment plan, you may be back in the boxing ring in no time!