What Ails You: Many reasons may lead to a tendon rupture
My shoulder patient was doing well until, one day, he came in complaining of pain when he reached for his coffee cup. The pain had been short and quick in the front of his arm. The pain went away almost immediately, but he developed a terrible bruise over the area and quickly developed what he thought was severe swelling near his elbow in the front of his arm. He also found that his arm was suddenly weak. He could lift it out to the side easily enough, but he could not lift it straight up in front.
My patient had ruptured his biceps tendon. We are all familiar with sprains and strains where we overstretch the tendon or ligament, but in a rupture, the muscle is actually torn away from the tendon or the tendon torn away from the bone. The biceps, one of the muscles responsible for flexing our elbow or reaching our arm overhead, attaches to the arm by tendons at the shoulder and at the elbow. When one or the other of these tendons rupture, the biceps forms a ball as it folds up inside the arm. Attempting to bend the elbow will contract the bicep, but because the tendon is not attached at both ends, the little ball just seems to get firmer; no motion actually occurs.
Although biceps tendon ruptures normally occur in older folks, younger people, especially men, may tear the biceps while they are doing testosterone-heavy things like lifting ridiculously heavy weights or blasting about the desert on their dirt bikes. In older folks, the tendons have become thin and tissue like. Finally, the tendon gives way under only slight pressure like when my patient reached for his cup.
Most folks who experience a tendon rupture will report that for quite some time before the rupture they had some shoulder pain. They were experiencing the pain of an impingement syndrome, when the tendon is pinched between other tissues or between bony structures. When the tendon finally gives way, there may be an audible snap in the area of the shoulder and a sudden pain. The pain is brief and afterward the shoulder often feels better than it has in some time. The inflamed tissues are no longer being stretched or pinched. When pain does persist after the rupture, it may indicate another persistent problem in the shoulder that needs attention.
Looking down at the arm after the rupture, a muscle bulge appears off center. In the elderly, the bulge is not as pronounced because the muscle was not well defined to begin with. In young folks who are injured lifting weights, however, the bulge can be quite pronounced giving the bicep a “Popeye” appearance.
After an initial period of healing, patients do not usually notice a big loss of arm or shoulder function. Biceps means “two heads.” Because only part of the muscle drops, the other part is left to do at least some of the work. Surgical repair is normally only considered in younger folks or when the rupture is at the elbow end rather than the shoulder end. In the elderly the tissues are so soft and delicate they don’t hold up to the repair well. Repairing a rupture at the elbow end of the muscle is imperative because without elbow flexion you lose quite a bit of your ability to care for your own feeding and hygiene not to mention the lost ability for work and recreational activities.
You may need to see your physical therapist after the tendon rupture and especially after surgical repair. It is important that you relearn how to raise your arm and maximize the use of the muscle that remains. There are some movements which will remain difficult, if not impossible, like raising your arm straight up in front. Simply by moving your arm out toward the side a bit, you use other muscles to help the weakened biceps and you will be able to raise your arm overhead. With a little bit of work and regular exercise, you will have your arm back to almost normal in no time.
ABOUT THE WRITER:
Jackie Randa is a physical therapist who owns Back on Track in Barstow. She can be contacted at jranda@aol.com
