Anatomy
The upper arm muscle (M biceps brachii) has 2 tendons that attach to the shoulder blade. The two tendons unite to form the muscle on the upper arm and attach just below the elbow joint on the radius. The function of the biceps muscle is to bend the elbow and rotate the forearm so that the palm faces up (supinate).
Cause
With repeated repetitive repetitive (over)loading (bending at the elbow, flexion) and rotation of the forearm (supination) with the palm facing up, the strength of the tendon is exceeded. This causes microscopic tears in the front of the tendon, resulting in an (inflammation) of the tendon. The tendonitis is a warning that the training is too strenuous for the muscle tendon in question.
Prolonged overuse can result in the biceps tendon rupturing at the elbow.The tendon usually ruptures with a heavy load (weightlifting, judo, contact sports).Ruptures most often occur if the muscle contracts while being stretched (eccentric contraction).
Ruptures are often localised at the attachment of the radius. Long-term inflammation (tendinitis) and wear and tear (degeneration) increase the risk of rupture.
Symptoms
During strain, you experience a sudden pain and the sensation of a pop at the elbow.
Examination
Diagnosis is usually made during a general clinical examination where there is pain and reduced power when the elbow is flexed against resistance or when the hand is rotated with the palm facing up (supination). When the elbow is bent 90 degrees and the palm is facing up, the examiner can press a finger under the tendon and test for attachment (Hook test).
In some cases, it may be necessary to supplement with an ultrasound scan (or MRI scan) for rapid diagnosis and treatment (Deschrijver M, et al. 2022).
Treatment
Treatment includes relief from pain-inducing activity, stretching and slowly increasing strength training of the upper arm muscles within the pain threshold. If the discomfort does not subside during rehabilitation, treatment can be supplemented with medication in the form of arthritis pills r (NSAID) or adrenal cortal hormone as part of slow rehabilitation over several months before maximum load is allowed (often 3-6 months).
If there is a total rupture of the biceps tendon in the elbow, the rupture should be operated on as soon as possible, fixing the tendon to the radius to prevent permanent loss of strength. Often the arm is bandaged for a few weeks after surgery.
Rehabilitation, especially
In case of rupture and surgery, rehabilitation within the pain threshold can start 2 weeks after surgery and should follow the surgeon’s instructions. Heavy loading is usually only possible after 3-6 months of rehabilitation.
Complications
After rapid surgery for rupture of the biceps tendon at the elbow attachment, the prognosis is usually good. 95% return to sport and 80% return to the same level of activity (Wörner EA, et al. 2023)
