Biceps Tendon Disruption Proximal

What is Biceps Tendon Disruption Proximal

The proximal biceps tendon is a strong cord of tissue that connects the biceps muscle, on the front of the upper arm, to the shoulder blade. A proximal biceps tendon disruption can include a partial or complete tear of the tendon near where it connects to the bone near the shoulder.

A proximal biceps tendon disruption can interfere with the ability to lift the arm in front of the body, stabilize the shoulder, bend the elbow, and turn the hand palm-up (supination).

What are the causes?

A biceps tendon disruption happens when the tendon is exposed to too much force. This excess force may be caused by:

  • The elbow being suddenly straightened from a bent position because of an external force. This could happen, for example, while catching a heavy weight or being pulled when waterskiing.
  • Wear and tear from physical activity.
  • Breaking a fall with your hand.

What increases the risk?

The following factors may make you more likely to develop this condition:

  • Playing contact sports.
  • Doing activities or sports that involve throwing or overhead movements, such as racket sports, gymnastics, or baseball.
  • Doing activities or sports that involve putting sudden force on the arm, such as weightlifting or waterskiing.
  • Having a weakened tendon. The tendon may be weak because of:
    • Long-lasting (chronic) biceps tendinitis.
    • Certain medical conditions, such as diabetes or rheumatoid arthritis.
    • Repeated corticosteroid use.
    • Repetitive overhead movements.

What are the signs or symptoms?

Symptoms of this condition may include:

  • Sudden sharp pain in the front of the shoulder. Pain may get worse during certain movements, such as:
    • Lifting or carrying objects.
    • Straightening the elbow.
    • Throwing or using overhead movements.
  • Inflammation or a feeling of unusual warmth on the front of the shoulder.
  • Painful tightening (spasm) of the biceps muscle.
  • A bulge on the inside of the upper arm when the elbow is bent.
  • Bruising in the shoulder or upper arm. This may develop 24–48 hours after the tendon is injured.
  • Limited range of motion of the shoulder and elbow.
  • Weakness in the elbow and forearm when:
    • Bending the elbow.
    • Rotating the wrist.

How is this diagnosed?

This condition is diagnosed based on your symptoms, your medical history, and a physical exam. Your health care provider may test the strength and range of motion of your shoulder and elbow. You may have imaging tests, such as X-rays, MRI, or ultrasound.

How is this treated?

This condition is treated by resting and icing the injured area, and by doing physical therapy exercises. Depending on the severity of your condition, treatment may also include:

  • Medicines to help relieve pain and inflammation.
  • Avoiding certain activities that put stress on your shoulder.
  • One or more injections of medicines (corticosteroids) into your upper arm to help reduce inflammation (rare).
  • Surgery to repair the tear. This may be needed if nonsurgical treatments do not improve your condition.

Follow these instructions at home:

Managing pain, stiffness, and swelling

  • If directed, put ice on the injured area:
    • Put ice in a plastic bag.
    • Place a towel between your skin and the bag.
    • Leave the ice on for 20 minutes, 2–3 times a day.
  • Move your fingers often to avoid stiffness and to lessen swelling.

Raise (elevate) the injured area while you are sitting or lying down.

Activity

  • Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
  • Avoid activities that cause pain or make your condition worse.
  • Do notlift anything that is heavier than 10 lb (4.5 kg) until your health care provider approves.
  • Do exercises as told by your health care provider.

General instructions

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Do notdrive or operate heavy machinery while taking prescription pain medicines.
  • Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

  • Warm up and stretch before being active.
  • Cool down and stretch after being active.
  • Give your body time to rest between periods of activity.
  • Make sure to use equipment that fits you.
  • Be safe and responsible while being active to avoid falls.
  • Maintain physical fitness, including strength and flexibility.

Contact a health care provider if:

  • You have symptoms that get worse or do not get better after 2 weeks of treatment.
  • You develop new symptoms.

Get help right away if:

  • You have severe pain.
  • You develop pain or numbness in your hand.
  • Your hand feels unusually cold.
  • Your fingernails turn a dark color, such as blue or gray.

Biceps Tendon Disruption (Proximal) Rehab

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your arm and shoulder. These exercises also help to relieve pain and stiffness.

Exercise A: Shoulder flexion, standing

  1. Stand facing a wall. Put your left / right hand on the wall.
  2. Slide your left / right hand up the wall. Stop when you feel a stretch in your shoulder, or when you reach the angle recommended by your health care provider.
    • Use your other hand to help raise your arm, if needed.
    • As your hand gets higher, you may need to step closer to the wall.
    • Avoid shrugging your shoulder while you raise your arm. To do this, keep your shoulder blade tucked down toward your spine.
  3. Hold for __________ seconds.
  4. Slowly return to the starting position. Use your other arm to help, if needed.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise B: Pendulum

  1. Stand near a wall or a surface that you can hold onto for balance.
  2. Bend at the waist and let your left / right arm hang straight down. Use your other arm to support you.
  3. Relax your arm and shoulder muscles, and move your hips and your trunk so your left / right arm swings freely. Your arm should swing because of the motion of your body, not because you are using your arm or shoulder muscles.
  4. Keep moving so your arm swings in the following directions, as told by your health care provider:
    • Side to side.
    • Forward and backward.
    • In clockwise and counterclockwise circles.
  5. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your arm and shoulder. Endurance is the ability to use your muscles for a long time, even after your muscles get tired.

Exercise C: Elbow flexion, neutral

  1. Sit on a stable chair without armrests, or stand.
  2. Hold a __________ weight in your left / right hand, or hold an exercise band with both hands. Your palms should face each other at the starting position.
  3. Bend your left / right elbow and move your hand up toward your shoulder.
    • Lead with your thumb, and keep your palm facing the same direction.
    • Keep your other arm straight down, in the starting position.
  4. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Forearm supination

  1. Sit with your left / right forearm on a table. Your elbow should be below shoulder height. Rest your hand over the edge of the table so your palm faces down.
  2. If directed, hold a hammer with your left / right hand.
  3. Without moving your elbow, slowly rotate your hand so your palm faces up toward the ceiling.
    • If you are holding a hammer, begin by holding the hammer near the head. When this exercise gets easier for you, hold the hammer farther down the handle.
  4. Hold for __________ seconds.
  5. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Scapular retraction

  1. Sit in a stable chair without armrests, or stand.
  2. Secure an exercise band to a stable object in front of you so the band is at shoulder height.
  3. Hold one end of the exercise band in each hand.
  4. Squeeze your shoulder blades together and move your elbows slightly behind you. Do notshrug your shoulders.
  5. Hold for __________ seconds.
  6. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise F: Scapular protraction, supine

  1. Lie on your back on a firm surface. Hold a __________ weight in your left / right hand.
  2. Raise your left / right arm straight into the air so your hand is directly above your shoulder joint.
  3. Push the weight into the air so your shoulder lifts off of the surface that you are lying on.Do notmove your head, neck, or back.
  4. Hold for __________ seconds.
  5. Slowly return to the starting position. Let your muscles relax completely before you repeat this exercise.

Repeat __________ times. Complete this exercise __________ times a day.

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