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July 23, 2007

Biceps Tendon Rupture - What Does it Mean?

Frequently patients with long term shoulder pain will at certain times develop a sudden worsening of this long term pain and come in for an assessment which will frequently involve an MRI.  It is not uncommon when someone has had years of shoulder pain to find a rupture of their biceps tendon.  This causes great distress amongst patients and typically represents accumulation of years of inflammation in the rotator cuff area.  The biceps tendon longhead of the biceps tendon inserts deeply into the shoulder joint and attaches fairly close to where the primary inflammation of rotator cuff tendonitis.  Frequently when the rotator cuff is inflamed the patient will have a cycle of inflammation, pain, and there is some collateral damage unfortunately when the longhead of the biceps tendon is surrounded by this inflammation and swelling. 


The surprising aspect of this tendon rupture is that it does not particularly impair the patient’s functionality of their arm.  The superior aspect of the bicep where it attaches to the upper arm has actually two attaches.  The longhead of the biceps tendon accounts for anchoring the smaller portion of the muscle.  Additionally, when this part of the muscle has been exposed to so much inflammation, it will become weaker over time.  Therefore, the patient may have this loss of the tendon, but the other superior attachment of the biceps tendon will basically be able to give them adequate strength and function.  So, if someone’s bicep tendon does rupture, it typically means they have a fairly severe rotator cuff problem.  What it does not mean is that it is absolutely necessary that they get surgery.  We can expect that some people will get better with physical therapy and certainly all people should have a trial physical therapy even if they go to their doctor at their initial assessment they have a ruptured biceps tendon.  Certainly some of these people will end up with rotator cuff reconstruction, however, the patient should know that most of the time; the biceps tendon is not reattached because it frankly doesn’t need to be.


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I had a fall backwards and tried to break the fall by landing on my hands several months ago. I recently had an MRI that revealed thickening and increased signal within the supraspinatus tendon denoting tendinosis. A prominent subacromial osteophyte with inferior tilting of the anterior acromion. There is impact upon the musculotendinous junction of the supraspinatus. Degenerative superior labvral tearing is seen. Small degenerative subcortical cysts are seen subjacent to the infraspinatus insertion at the greater tuberosity. Minimal fluid is seen within the subacromial/subdeltoid bursa. No significant joint effusion is seen. There is contact of the musculotendinous junction of the supraspinatus and these findings can be seen in concert with the clinical diagnosis of shoulder impingement. Mild supraspinatus and moderate intraarticular long head of biceps tendinosis. Degenerative tearing of the superior labrum. Mild subacromial/subdeltoid bursitis. While getting dressed for work this week, I noticed a lump about midway in my biceps and another lump on my triceps further up toward top of shoulder. I have pain under my arm that radiates under my breast and goes to my elbow and even pain in my shoulder blade. Could the lumps that I have just found be a ruptured tendon??? I am very concerned about my discovery. Should I notify the ortho or go to the emergency room? I would appreciate any good medical advice.

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