| Overview | | | | Strengthening |
| A professional football player attempts an arm tackle | | | | Begin strengthening exercises for your biceps and arm |
| and hears a pop in his upper arm. A weightlifter doing | | | | muscles as recommended by your doctor. |
| curls suddenly feels his shoulder "bubble." A woman | | | | Gradual Return to Your Sport |
| rearranging the living room furniture gets a sharp pain in | | | | Begin light arm motions of your sport or activity as |
| her shoulder. Each of these individuals just ruptured | | | | recommended by your doctor. (For example: passing a |
| their biceps tendon. | | | | football, throwing a baseball, tennis strokes, golf |
| Tendons attach muscle to bone. The biceps muscle in | | | | swings). Refrain from forceful biceps use such as |
| the upper arm splits near the shoulder into a long head | | | | weightlifting, until arm is fully healed. |
| and a short head. Both attach to the shoulder in | | | | Surgery |
| different places. At the other end of the muscle, the | | | | Surgical repair may be necessary for of a complete |
| distal bicep tendon connects to the smaller bone | | | | tendon tear. |
| (radius) in the lower arm. These connections help the | | | | Stretching Exercises |
| muscle stabilize the shoulder, rotate the lower arm and | | | | The major objectives of rehabilitation from a biceps |
| accelerate or decelerate the arm during overhead | | | | rupture are to improve the elasticity of the biceps |
| motions such as pitching. | | | | muscle and to gradually increase pain-free range of |
| The long head of the biceps tendon is vulnerable to | | | | motion. The exercises below stretch the muscles of |
| injury because it travels through the shoulder joint to its | | | | the forearm and upper arm. These exercises should |
| attachment point. If it tears, you may lose some | | | | be performed once or twice daily. Exercises include: |
| strength in your arms and be unable to turn your arm | | | | Bicep stretch |
| from palm down to palm up. Because the torn tendon | | | | Stand erect with arms raised to shoulder height and |
| can no longer keep the muscle taut, you may also | | | | palms up. Press arms backward until stretch is felt. |
| notice a bulge in the upper arm (Popeye muscle). If the | | | | Hold this position for three to five seconds, then relax |
| distal tendon tears, you may be unable to lift items or | | | | for 3 to 5 seconds. Perform this exercise 10 times. |
| bend your elbow. | | | | The bicep is stretched by this exercise as well as the |
| Possible Causes | | | | muscles of the shoulder and upper chest. |
| Ruptures of the distal tendon near the elbow are rare. | | | | Wrist flexor stretch |
| They usually occur when an unexpected force is | | | | Extend affected arm forward with palm up and elbow |
| applied to a bent arm. For example, a snowboarder | | | | straight. Place fingers and palm of opposite hand |
| can rupture the distal biceps tendon if he uses the arm | | | | across palm and fingers of the extended hand and |
| to try to break a fall during a turn. | | | | draw back with it until stretch is felt in the forearm. |
| The proximal biceps tendons near the shoulder tear | | | | Hold this position for 3 to 5 seconds, then relax for |
| more easily. Tears can be either partial or complete. | | | | three to five seconds. Perform this exercise 10 times. |
| Often, these tendons are already frayed, particularly if | | | | Wrist extensor stretch |
| you are over 40 years old, have a history of shoulder | | | | Extend affected arm forward with palm down, elbow |
| pain, and participate in activities that involve overhead | | | | straight, and fingers slightly curled. Grasp the affected |
| motions. Among the elderly, biceps tendon ruptures | | | | side hand with other hand and draw affected side |
| near the shoulder are often associated with rotator | | | | hand down until stretch is felt in the forearm. Hold this |
| cuff tears. | | | | position from 3 to 5 seconds, then relax for 3 to 5 |
| Diagnosis | | | | seconds. Perform this exercise 10 times. |
| Signs and Symptoms | | | | Pronation/Suppination stretch |
| Conservative treatment for biceps tendonitis can | | | | Extend affected arm forward in a hand-shaking |
| include:sudden, sharp pain in the upper arman audible | | | | position with palm facing up. Slowly rotate the hand |
| snap (sometimes)a bulge in the upper arm above the | | | | from a palm-up position to a palm-down position. Hold |
| elbow, and a dent closer to the shoulderbruising from | | | | for 3 to 5 seconds and then rotate back. Perform this |
| the middle of the upper arm down toward the | | | | exercise 10 times. When you work your way up to |
| elbowpain or tenderness at the shoulder | | | | strength training, you may use a small weight while |
| Your physician will examine your arm and ask you to | | | | rotating the hand and wrist. |
| bend the arm and tighten the bicep muscle. The doctor | | | | Tricep stretch |
| may apply pressure to the top of the arm to see if | | | | Stand erect with feet at about shoulder width. Raise |
| there is any pain. If you have a history of shoulder pain, | | | | injured arm at the shoulder with elbow bent and place |
| your doctor may request an magnetic resonance | | | | the forearm behind the head. Grasp the injured elbow |
| imaging (MRI) scan or a special x-ray called an | | | | with opposite hand and draw it toward the center of |
| arthrogram to see if you have also torn the rotator | | | | the body until stretch is felt. Hold this position for 3 to 5 |
| cuff muscle. | | | | seconds, then relax for 3 to 5 seconds. Perform this |
| Treatment Options | | | | exercise 10 times. |
| Conservative treatment is usually all that is needed for | | | | Strengthening exercises |
| tears in the proximal biceps tendons. Ice applications | | | | The following exercises develop strength of the |
| keep down the swelling, and nonsteroidal | | | | muscles of the forearm and upper arm. It's important |
| anti-inflammatory medications (NSAIDS) such as | | | | to get your doctor's permission before beginning |
| ibuprofen reduce pain. | | | | strengthening exercises. To maintain symmetry of the |
| You should rest the muscle, limiting your activity when | | | | arms in terms of strength and appearance, perform |
| you feel pain or weakness. To keep the shoulder | | | | these with the uninjured arm as well as the injured arm. |
| mobile and strengthen the surrounding muscles, your | | | | Arm curls |
| doctor may prescribe some flexibility and strengthening | | | | Either standing or sitting, grasp a 2- to 4-pound |
| exercises. | | | | dumbbell in one hand. With palm up, flex elbow and |
| Complete tears of the distal biceps tendon require | | | | draw the dumbbell up to the same side shoulder while |
| surgery to reattach the tendon to the bone. Range of | | | | maintaining erect posture. Do not bend at the waist or |
| motion exercises can begin as early as two weeks | | | | swing the dumbbell. Lower dumbbell slowly and with |
| after surgery, although forceful biceps activity is often | | | | control to the starting position. Repeat this exercise 10 |
| restricted for four to six months. Partial tears of the | | | | times. Use a heavier dumbbell as strength increases. |
| distal biceps tendon may be treated either | | | | Wrist extension |
| conservatively or surgically. You and your orthopaedic | | | | Sit in a chair with forearm resting on the end of a table, |
| surgeon should discuss the options for your specific | | | | palm down. Grasp a light weight dumbbell and raise the |
| case. | | | | weight up as high as possible while maintaining contact |
| Surgical repair of a complete tendon tear can be done | | | | with the table top. Hold this position for 3 to 5 seconds. |
| for younger individuals whose work involves heavy | | | | Relax for 3 to 5 seconds. Repeat this exercise 5 to 10 |
| labor or lifting. | | | | times. Substitute a heavier dumbbell as strength |
| | | | increases. |
| How can I prevent a biceps rupture? | | | | Alternative exercises |
| The best way to prevent reoccurrences of a biceps | | | | During the period when normal training should be |
| rupture is to only return to practice and competition | | | | avoided, alternative exercises may be used. These |
| when all symptoms of the injury are gone and strength | | | | activities should not require any actions that create or |
| of the affected arm has returned to normal. | | | | intensify pain at the site of injury. They |
| Furthermore, the rehabilitation exercises should be | | | | include:swimming (if pain allows)joggingstationary |
| continued to ensure protective strength, range of | | | | bicycle |
| motion, and stability of the injured joint. Other | | | | Rehabilitation after surgery |
| prevention techniques include:maintain flexibility by | | | | Your biceps rupture may require surgery to reattach |
| performing proper stretching exercises before and | | | | the tendon to the bone. Keep in mind that the soft |
| after playing sportsmaintain strength by exercising | | | | tissue needs time to heal before exercise can begin. A |
| regularlytake extra caution when weightlifting and don't | | | | physical therapy program usually begins with |
| lift more than you can handlelisten to your body and | | | | range-of-motion and resistive exercises, then |
| know when to take a rest | | | | incorporates power, aerobic and muscular endurance, |
| Improving Sports Performance | | | | flexibility, and coordination drills. |
| The key to improving sports performance after | | | | Finally, patients develop speed and agility through |
| recovering from a biceps rupture is a proper a | | | | sport-specific exercise routines. |
| rehabilitation program, and adhering to some of those | | | | The ultimate goal of surgery is to provide dynamic |
| same principles after the injury is gone. | | | | stability while maintaining full range of motion, so that |
| The single most important aspect of improving | | | | athletes can return to competitive or recreational |
| performance is stretching before and after you step | | | | sports. Progress is assessed by the patient's |
| onto the field, court, ice, or golf course. | | | | perception of how stable the biceps muscle feels and |
| Benefits derived from stretching include:increased | | | | by comparing the strength and stability of the injured |
| physical efficiency and performancedecreased risk of | | | | and uninjured arms. |
| injuryincreased blood supply and nutrients to joint | | | | How long will the effects of my injury last? |
| structuresincreased coordinationimproved muscular | | | | The goal of rehabilitation is to return you to your sport |
| balance and postural awarenessreduced | | | | or activity as soon as is safely possible. If you return |
| stressenhanced enjoyment | | | | too soon you may worsen your injury, which could |
| Rehabilitation for a biceps rupture | | | | lead to permanent damage. Everyone recovers from |
| As an athlete, your number one concern is getting | | | | injury at a different rate. Return to your activity is |
| back to full strength as soon as possible so that you | | | | determined by how soon your biceps rupture |
| can return to training and competition. That is why | | | | recovers, not by how many days or weeks it has |
| appropriate rehabilitation is extremely important. The | | | | been since your injury occurred. |
| most common rehabilitation for a biceps rupture often | | | | It also depends on how serious the injury is. Instances |
| includes the following: | | | | where you have a complete tear of the distal biceps |
| Rest | | | | tendon, and reconstructive surgery is required, may |
| Avoid activity during the acute phase. Refrain from | | | | require up to 6 months before you can return to full |
| forceful biceps use such as weightlifting until arm is fully | | | | participation. For patients with a partial tear, you may |
| healed. | | | | be back to normal activity in 2 to 3 months. |
| Ice | | | | A good rule is to allow pain to dictate when you're |
| Apply ice or a cold pack to the biceps muscle for 15 to | | | | ready to return to activity. You should return in |
| 20 minutes, 4 times a day for several days to keep | | | | moderation, and back off if you feel any pain. |
| swelling down. Wrap the ice or cold pack in a towel. | | | | You may safely return to your sport or activity when |
| Do not apply the ice directly to your skin. | | | | you have full strength and range of motion in the |
| Medication | | | | injured arm compared to the uninjured arm. |
| Take ibuprofen to help reduce inflammation and pain. | | | | When can I return to my sport or activity? |
| Stretching | | | | Gentle rehabilitation exercises may be performed |
| When the acute pain is gone, start gentle stretching | | | | within a few weeks, but keep in mind that forceful |
| exercises as recommended by your doctor. Stay | | | | biceps activity is often restricted for 4 to 6 months. Of |
| within pain limits. Hold each stretch for about 10 | | | | course, time for return to activity is much longer when |
| seconds and repeat 6 times. | | | | surgery is necessary. |