What is a Long Head Bicep Rupture?

Understanding a Long Head of Biceps Brachii Tendon Rupture

Proximal biceps brachii tendon ruptures (bicep ruptures) are more common than one would think. High intensity athletes, especially those involved in contact sports, are prone to this injury.

These cases involve injuries to the long head of the biceps brachii, rather than the short head. Specifically, the long head is more vulnerable to injury as it passes over the shoulder joint and attaches to the top of the glenohumeral joint.

A biceps tendon rupture involves a longitudinal laceration along the tendon of the long head. This vulnerable tissue attaches a group of fibers from the belly of the biceps muscle higher up at the shoulder joint itself.

This injury is seen mainly in active individuals as a direct result of repetitive forces experienced at the attachment mentioned above. Specifically, it is linked to intense weightlifting activities performed by determined athletes trying to reach the top of their game.

Fractures are sometimes a factor, especially stress fractures located in the neck of the upper arm or humerus bone. Tears of the long head of the biceps can be partial or complete, and partial tears can progress into the latter variety if left untreated. Secondary complications such as an impingement syndrome, rotator cuff tendon tear, and labral tears are sometimes directly related to chronic proximal bicep issues.

At the time of a long head tendon rupture, the athlete may feel/hear a pop or snap. Perhaps surprisingly, this is often not overly painful.

It is important to confirm the injury is indeed a tendon tear and not a topical tendon inflammation (tendinitis), as these present with similar signs and symptoms.

Signs and Symptoms of a Ruptured Long Head of Biceps Brachii Muscle

  • A “spasm bulge” in the lower part of the arm. This is due to the biceps brachii muscle belly involuntarily contracting without its regular check by the long head tendon attachment above the shoulder joint. The intact short head is able to hold the muscle in position but is not overly effective.
  • Localized sharp pain originating in the front of the shoulder and radiating downward to the muscle belly
  • An audible pop or snap at the time of injury
  • Rapidly fatiguing biceps muscle with activity
  • Pain, tenderness, weakness and considerable difficulty eliciting shoulder and elbow movements

Professional Treatment for Ruptured Tendon of Long Head of Biceps Brachii

  • Rest the shoulder and elbow joints while consistently icing the anterior shoulder and upper arm to minimize both swelling and pain.
  • Avoid strenuous arm activity for at least two weeks and:
    • Utilize the latest physical therapy modalities and rehab devices to reduce swelling and pain.
    • Increase your Vitamin C intake to assist your body’s ability to produce fibroblasts, which synthesize ever-important collagen.
    • Restore flexibility and range of motion of the shoulder joint, shoulder girdle and elbow joint.
    • Discuss treatment options with your physician. Non-operative approaches are most common, but consider surgical options when specific issues such as past medical history, intended level of activity, and degree of limitation merit the need for surgery.
    • As range of motion and pain improve, integrate progressive resistive (strengthening) exercises into the rehab plan.  Carefully monitor isolated bicep curls and resistive shoulder flexion exercises, which should progress more slowly than other motions due to stress placed on the shoulder joint.
    • Be diligent in your physical therapy regimen, which should include strengthening, flexibility, proprioception, and cardiovascular exercises.

Ask the Right Questions Like the Pros

Here’s what smart pro athletes would ask their sports medicine specialist to ensure a fast and safe return to the game they love:

1. Is this injury a ruptured biceps muscle tendon or a partial tear?

2. Are additional diagnostic procedures needed to rule out the possibility of other injuries?

3. Is there secondary damage to any other structure(s) around my shoulder?

4. Do you think surgery is required for this injury?  If not, what are the short and long-term risks of conservative treatment?

5. Where are your top three physical therapy recommendations to rehabilitate this injury?

6. In your opinion, what is the timeframe needed before I can return to my usual routine?

Elite Sports Medicine Tips from Mike Ryan

  • Relax – The right frame of mind proves a helpful tool with this type of injury.  Managing a rupture the correct way will foster a quick return to your normal activities.
  • Rehab Diligently – Don’t let distractions hinder you from executing your physical therapy plan.
  • Realize the Risks – If you fail to rehab your shoulder/arm properly, altered shoulder mechanics may predispose you to other injuries such as an impingement syndrome, bursitis, tendonitis, and early arthritis.
  • Refrain from Pain – Thoroughly evaluate your daily routine, avoiding activities that aggravate your biceps muscle and shoulder joint and in turn stall your progress.