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The various tendon & ligament injuries treated by Dr. Jason Henry-Shrouder include:

What is a Biceps Tendon Rupture?

The biceps muscle is located in the front side of your upper arm and functions to help you bend and rotate your arm.

The biceps tendon is a tough band of connective fibrous tissue that attaches your biceps muscle to the bones in your shoulder on one side and the elbow on the other side.

Overuse and injury can cause fraying of the biceps tendon and eventual rupture.

A biceps tendon rupture can either be partial, where it does not completely tear or complete, where it splits in two and is torn away from the bone.

The biceps tendon can tear at the shoulder joint or elbow joint. Most biceps tendon ruptures occur at the shoulder, which is referred to as a proximal biceps tendon rupture. When it occurs at the elbow it is referred to as a distal biceps tendon rupture and is less common.

Causes of Biceps Tendon Rupture

Biceps tendon ruptures occur most commonly from an injury, such as a fall on an outstretched arm, or from overuse of the muscle, either due to age or from repetitive overhead movements such as with tennis and swimming.

Biceps tendon ruptures are common in people over 60 who have developed chronic micro-tears from degenerative change and overuse. These micro-tears weaken the tendon, making it more susceptible to rupture.

Other causes can include frequent lifting of heavy objects at work, weightlifting, long-term use of corticosteroid medications and smoking.

Symptoms of Biceps Tendon Rupture

The most common symptoms of a biceps tendon rupture include:

  • Sudden, sharp pain in the upper arm
  • An audible popping sound at the time of injury
  • Pain, tenderness, and weakness at the shoulder or elbow
  • Trouble turning the arm palm-up or palm-down
  • A bulge above the elbow (the “Popeye” sign)
  • Bruising to the upper arm

Diagnosis of Biceps Tendon Rupture

Your doctor diagnoses a biceps tendon rupture after observing your symptoms and taking a medical history. A physical exam is performed where your arm may be moved in different ways to see which movements elicit pain or weakness. Imaging studies such as X-rays may be ordered to assess for bone deformities such as bone spurs, which may be the cause, or an MRI scan to determine whether the tear is partial or complete.

Treatment Options

Non-surgical Treatment: Non-surgical treatment is an option for patients whose injury is limited to the top of the biceps tendon. This includes:

  • Rest: A sling is used to rest the shoulder, and you are advised to avoid overhead activities and lifting heavy objects until the bicep tendon has healed.
  • Ice: Applying ice packs for 20 minutes at a time, 3 to 4 times a day, to help reduce swelling.
  • Medications: Non-steroidal anti-inflammatory medicines help reduce pain and swelling.
  • Physical therapy: Strengthening and flexibility exercises help restore strength and mobility to the shoulder joint.

Surgical Treatment

Surgery may be necessary for patients whose symptoms are not relieved by conservative measures and for patients who require full restoration of strength, such as athletes.

Your surgeon makes an incision either near your elbow or shoulder, depending on which end of the tendon is torn. The torn end of the tendon is cleaned and the bone is prepared by creating drill holes. Sutures are woven through the holes and the tendon to secure it back to the bone and hold it in place. The incision is then closed and a dressing applied.

Risks and Complications

As with any surgery, complications can occur related to the anesthesia or the procedure. Most patients suffer no complications following biceps tendon repair; however, potential complications include:

  • Infection
  • Nerve damage
  • Re-rupture of the tendon

Elbow Anatomy

The elbow is a joint made up of three bones: the upper arm bone, the humerus, and the two forearm bones, the radius and ulna. The lower end of the humerus has bony bumps called epicondyles that serve as sites of attachment for major tendons and muscles that help in arm movement. The bump on the inside of the elbow is called the medial epicondyle. It helps in the attachment of the tendons and muscles that help extend your fingers and wrist.

What is Golfer’s Elbow?

Golfer’s elbow, also called medial epicondylitis, is a painful condition occurring from repeated muscle contractions in the forearm that leads to inflammation and microtears in the tendons that attach to the medial epicondyle.

Golfer’s elbow and tennis elbow are similar, except that golfer’s elbow occurs on the inside of the elbow and tennis elbow occurs on the outside of the elbow. Both conditions are a type of tendonitis - inflammation of the tendons.

Causes of Golfer’s Elbow

Golfer’s elbow is usually caused by the overuse of the forearm muscles and tendons that control wrist and finger movement, but may also be caused by direct trauma such as a fall, car accident or work injury.

Golfer’s elbow is commonly seen in golfers; hence the name. It occurs especially when poor technique or unsuitable equipment is used when hitting the ball. Other common causes include any activity that requires repetitive motion of the forearm such as painting, hammering, typing, raking, pitching sports, gardening, shoveling, fencing and playing golf.

Signs and Symptoms of Golfer’s Elbow

The signs and symptoms of golfer’s elbow can include the following:

  • Elbow pain that appears suddenly or gradually
  • Achy pain to the inner side of the elbow during activity
  • Elbow stiffness with decreased range of motion
  • Pain that radiates to the inner forearm, hand or wrist
  • Weakened grip
  • Increased pain while gripping objects
  • Increased pain in the elbow when the wrist is flexed or bent forward toward the forearm

Diagnosis of Golfer’s Elbow

Your doctor will review your medical history and perform a thorough physical examination of your elbow joint. Your physician may order an X-ray to rule out a fracture or arthritis as the cause of your pain. Occasionally, if the diagnosis is unclear, further tests such as MRI, ultrasonography and injection test may be ordered to confirm golfer’s elbow.

Treatment Options for Golfer’s Elbow

Conservative Treatment Options for Golfer’s Elbow

Your physician will recommend conservative treatment options to treat the symptoms associated with golfer’s elbow. These may include the following:

  • Activity Restrictions: Limit the use and rest your arm from activities that worsen symptoms.
  • Orthotics: Splints or braces may be ordered to decrease stress on the injured tissues.
  • Ice: Ice packs applied to the injury will help reduce swelling and pain. Ice should be applied over a towel to the affected area for 20 minutes, four times a day for a couple of days. Never place ice directly over the skin.
  • Medications: Anti-inflammatory medications and/or steroid injections may be ordered to treat the pain and swelling.
  • Occupational Therapy: OT may be ordered for strengthening and stretching exercises once your symptoms have reduced.
  • Pulsed Ultrasound: This is a treatment used by therapists to break up scar tissue and increase blood flow to the injured tendons and promote healing.
  • Professional Instruction: Consulting a sports professional to assess and instruct in proper swing technique and appropriate equipment may be recommended to prevent recurrence.
  • Surgery for Golfer’s Elbow

    If conservative treatment options fail to resolve the condition and symptoms persist for 6 - 12 months, your surgeon may recommend surgery to treat golfer’s elbow. The goal of surgery is to remove the diseased tissue around the inner elbow, improve blood supply to the area to promote healing and alleviate the symptoms.