Acute Rupture of the Proximal Biceps Tendon in a 55-Year-Old Female

Abstract

Acute ruptures of the long head of the biceps (LHB) tendon typically occur in patients 40–60 years of age. The two main causes are a natural degeneration and fraying of the tendon that occurs slowly over time as part of the aging process and an acute traumatic event such as excessive weight lifting. Clinical history and a physical examination can raise suspicion for LHB rupture. Sharp, anterior shoulder pain, significant ecchymosis over the proximal arm extending toward the elbow, cramping in the biceps with use, a bulging biceps muscle (“Popeye” sign), and a visible indentation in the bicipital groove represent classic findings of a proximal biceps rupture. Magnetic resonance imaging should be performed to confirm the diagnosis and evaluate for any concomitant pathology, the most common of which is a rotator cuff tear.

Once the diagnosis of a LHB tendon rupture is confirmed, conservative or surgical management should be offered based on the patient’s age, activity level, and occupation. A majority of the time, this injury can be treated nonoperatively. Middle-aged to older patients who do not require high supination strength may proceed with conservative management consisting of nonsteroidal anti-inflammatory drugs and physical therapy. However, younger and more active patients or manual laborers should consider proceeding with surgery. In addition, patients who are dissatisfied by the cosmetic defect of a Popeye deformity may also elect to undergo surgery. Surgical treatment involves a biceps tenodesis, which is typically performed through an open subpectoral approach in the setting of a proximal biceps tendon rupture.