Tendons are tissues that connect muscles to bones... Biceps tendons connect this muscle to the bones of the shoulder and **elbow**. badge The brachii muscle has two tendon attachments in the shoulder, and a tear usually involves only one of these attachments. You may benefit from surgery to repair a torn tendon if: - Your symptoms will not go away with non-surgical treatments - Get intense and annoying biceps cramps - Feel significant pain in the shoulder Arm weakness prevents you from working or doing daily activities (such as bathing, dressing, cooking, cleaning, or shopping).. Anatomy The shoulder is a ball-and-socket joint consisting of three bones: - humerus - scapula (scapula) - clavicle (clavicle) The head or ball of the humerus (arm) is located in a round cavity in the scapula called the glenoid.. A set of muscles and tendons hold this ball in the center of the shoulder cavity... It connects the bones of the shoulder: the long head and the short tendon head, - The long head is connected to the top of the shoulder cavity (glenoid). The short head is connected to a small projection on the shoulder called the coracoid process. A biceps tendon tear in the shoulder can be partial or complete.... - Partial tear: the tendon is not completely separated from the bone and part of it is still intact.... In many cases, the tendon tear begins with wear and tear and gradually progresses and the tendon may be completely torn while lifting a heavy object. There is a possibility of damage to other parts of the shoulder such as rotator cuff tendons.... Causes of biceps tendon rupture in the shoulder There are two main reasons for tearing the biceps tendon in the shoulder: injury (impact) and overuse.... ### Injury: If you fall hard on your open hand or lift a very heavy weight, the biceps tendon may tear... ### Overuse: Many tears are caused by gradual wear and tear of the tendon over time, which is more common than direct injury and occurs naturally with age.. Repetitive shoulder movements make this condition worse.. Continuous overuse can cause a range of shoulder problems such as tendonitis, bursitis, impingement syndrome, and rotator cuff injury.. It causes more stress and damage to the tendon.. Risk Factors Increases tendon rupture give: - Increasing age: older people have more years of tendon wear than young people... - Heavy overhead activities: lifting heavy objects or tasks that require repeated lifting of objects above the head increase the risk of tearing. - Excessive use of the shoulder: sports such as swimming or tennis increase the amount of tendon wear. - Sudden and severe pain in the arm - Sometimes a cracking or tearing sound when damaged - Biceps muscle cramping during intense arm activity - Bruises from arm to elbow - Pain or sensitivity in shoulder and elbow - Weakness in shoulder and elbow - Difficulty rotating the hand (palm up or down) - "Papai muscle" or papi deformity: due to the rupture of the tendon and relaxation of the muscle, an abnormal bulge is created above the elbow... The muscle is seen near the elbow and more prominent than usual... Examination by a doctor (Dr. Homan Kukbi) ### History and physical examination After reviewing your symptoms and medical history, Dr. Homan Cookby will examine your shoulder.. The diagnosis of a complete tear is usually obvious due to a palpable change in the shape of the muscle (papi muscle).. It can happen with the biceps muscle. Tendon tears... Biceps tendon tears can also occur near the elbow (although less common). It can be useful... for treatment.. ### Non-surgical treatment of biceps tendon rupture in the shoulder For most patients, pain from a torn biceps tendon will improve over time. Mild weakness or changes in the appearance of the arm are usually not bothersome and patients can return to their activities and jobs without restriction. - Ice: use a cold compress for 20 minutes at a time, several times a day to reduce swelling... do not put ice directly on the skin. Aspirin or naproxen is useful to reduce pain and swelling... - Rest: to reduce pain and swelling, you should avoid lifting heavy objects and overhead activities... - Physiotherapy: doing flexibility exercises and strengthening muscles will restore movement and increase shoulder strength... ### Surgical treatment In most cases, the need for surgery for a tear of the long head of the biceps tendon is rare, but some people benefit from surgery, including those who: - Have severe muscle cramps - Have severe shoulder pain - Complete recovery of arm strength is necessary for them (such as athletes or manual workers). - They have partial tears and their symptoms do not improve with non-surgical treatment Surgical Procedure: Several different small incision techniques have been developed for tendon repair. The goal of surgery is to reattach the torn tendon to the shoulder. The tendon usually does not attach to the top of the glenoid, but to the humerus. It should be short. Use an arm strap to immobilize the shoulder. - Flexibility exercises improve shoulder range of motion... - Strengthening exercises are gradually added to the rehabilitation program... - Be sure to follow the treatment plan provided **by Dr. Cookby** step by step... Although the rehabilitation process is slow, your commitment to physical therapy is the most important factor in returning to all of your favorite activities.