DEAR MAYO CLINIC: I recently had a non-contrast MRI which showed a biceps tendon tear. I've already tried four months of physical therapy, rest, ice, anti-inflammatory medications and cortisone injections. Is surgery necessary and, if so, what does the recovery involve?
ANSWER: It sounds as if surgery could be a reasonable next step in treating this injury. Several surgical techniques can be used depending on the location and nature of the tear. The type of technique used determines your recovery time, which can range from just a few days to about three months.
Your biceps is the muscle at the front of your upper arm. You use it when you rotate your forearm and bend your elbow. Two tendons attach the bicep to your shoulder. These tendons combine into one that crosses the elbow and attaches to your forearm.
A biceps tendon tear can be either partial -- the tendon is not completely severed through -- or complete. A partial biceps tendon tear can be very irritating and lead to symptoms such as pain, tenderness and aching. A complete biceps tendon tear does not cause ongoing pain. But it does lead to a loss of forearm rotation strength, along with some pain if it occurs at the elbow.
Several treatment options are available for biceps tendon tears. Because you've already tried a number of more conservative treatments without success, surgery may be appropriate.
For a partial biceps tendon tear in the shoulder, one surgical approach is to complete the tear and release the damaged tendon from its attachment to the shoulder joint. As a result, the tear no longer irritates the joint and symptoms disappear.
With this procedure, called a tenotomy, you will lose little function in your biceps muscle. The other tendon that attaches to your shoulder can do the work instead. But because the tendon no longer keeps the muscle tight against the upper arm bone, it will leave a bulge in your upper arm. Some people are fine with that extra bulge. Others prefer to eliminate it by having the tendon reattached to the bone further down the arm.
A biceps tendon tear at the elbow is much less common than at the shoulder. Most often, elbow biceps tendon tears are complete. These tears usually are the result of a forceful extension of the elbow when, for example, you try to hold a heavy object with your palm up. The injury results in weakness when rotating the forearm and bending the elbow.
Surgical repair for complete tears should take place as soon as possible. If left untreated, the muscle and tendons begin to shorten and scar, making surgical repair difficult later.
If an elbow biceps tendon tear is partial and causes ongoing symptoms, it may be treated surgically by removing the affected tissue and reattaching the tendon to the bone using stitches or special screws. A similar technique can be used when a shoulder biceps tendon needs to be reattached.
Recovery time after surgery varies, depending on the procedure you have. When the shoulder tendon is simply released and not reattached, recovery is almost immediate. There are usually no restrictions on activity following that type of surgery.
When the tendon is reattached to the bone, healing takes about three months. Patients should not lift anything heavy for about six weeks after surgery. Manual labor, sports and other physical activities that involve your arm may be limited for another six weeks. Physical therapy can be done with a home-based program to regain the arm's strength and range of motion.
The long-term outlook often is good after surgery to treat a torn biceps tendon. The surgery typically relieves pain symptoms. Most people recover a full range of motion in their arm, and arm function is effectively restored. --Mark Morrey, M.D., Orthopedic Surgery,Mayo Clinic,Rochester, Minn.
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