Partial Bicep Tear Ever Fully Heal?

[ngoachoi]

I've read in some forums online that if you suffer from a partial bicep tendon tear that is more than 50% you might aswel undergo surgery to get it re-attached.

Is it true that a partial tear in a tendon will not heal it self? anyone has any insight or experience with this?

[alec_ar]

I can't say 100% for sure, but I did strain my biceps tendon pretty badly at the shoulder and it healed back fully. Maybe better than it was at the beginning I don't know how bad the strain was though because I never went to the doctor. So when it comes to tears, I'm not sure but I think you can get back to strength pretty decently in most cases.

[Joshua Naterman]

How it feels has nothing to do with the thickness of the tear.

 

If you have more than a 50% tear, then all clinical evidence suggests that you will never fully recover without surgery. That doesn't mean you won't get back to normal function, but it does mean that you will almost certainly re-injure yourself at a certain threshold. In other words, every time you get to a particular strength level it will be the limit of the incompletely healed tendon, and any more will cause injury despite the fact that the muscles are easily capable of more. There are, and will always be, exceptions to this but we're not talking about 30%, we're talking about less than 10%. It's a stupid gamble to try and heal a confirmed Grade III strain without surgery if you intend to be competitive or push your limits for fun.

 

The achilles tendon, in particular, is especially vulnerable to this issue. I do not know how this compares to the biceps tendon.

 

With large tears, you have a high probability of two things filling the void: Collagen (scar tissue) and fat tissue. Yes, fat. That does tend to happen more often with repeat injuries than with single injuries, which is another reason why we should all try to take care of our injuries properly from the start! If that means surgery, which it sometimes does, then so be it. Fatty degeneration generally requires swapping out the tissues for healthy tissue, but an initial injury can usually be sutured together.

 

Beats me why anyone would ever want to flirt with that risk.

 

MR: I think that you did not have a particularly severe strain. Even small strains feel god-awful. There's not a real way to tell by feel: The extent of bruising is what will tell the real story. If you showed bruising that covered the entire upper half of your bicep and part of the shoulder, I mean really severe, then yea you might have had a grade II or III.

 

Grade I = 1 to 25% tear

Grade II = 25 to 75% is torn. Yes, this is a wide range. On the upper end, surgery is a good option. On the lower end you can usually get complete recovery through conservative treatment.

 

Grade III = >75% torn. This is not always a full rupture, but there's not much functional difference.The ends are so far apart that they typically don't ever reconnect properly without surgery. There may be a few people out there with Wolverine-like healing factors that do so, but I don't remember seeing anything like this in the literature.

 

If you have an MRI that shows a large grade II or a grade III, feel free to tell me I'm wrong about my opinion regarding your injury! 

[AlexX]

Back in my tumbling days I tore a wrist ligament and did not get surgery right away (the doctor said I might not need it since he couldn't tell how bad it was in the MRI). Well after months of trying to do rehab as well as injections and resting it nothing happened and it still left me unable to do the most simple tasks never mind tumbling it on it.

I finally said this is ridiculous and just got surgery, well it turns out while the tendon did heal a bit, it healed very incorrectly with a bunch of cysts and other extra tissue in there that was causing me pain. He cleaned all that up and after 3 months I started slowly getting back into things. I did eventually get back to tumbling full force with no issues but total time lost was close to 8-9 months instead of half that if I had just got the surgery right away. Considering the fact that it was my last year on team it was a rather disappointing turnout.

I always tell people I am the biggest proponent against surgery. You can fix A LOT of stuff that doctors want to operate for in terms of injuries but serious tendon/ligament tears are just not one of them.

[ngoachoi]

Damn this post is pretty Scary, I injured my bicep tendon doing arm wrestle about a month ago. Was in pain for 2 weeks non stop. The pain started to fade on the third but then I went to a competition after the 4th week and re injured myself. Which wasn't even during my competition but after when I was messing about and held a long iron cross.

I have pain in both sides of my biceps tendon(shoulder and elbow) but had no visable swelling at all. One week later the pain has gone but i have not put much pressure on it yet. You guys think I should get it seen? Or does it sound like a minor injury?

[alec_ar]

Ha! Fat. That's funny. Yea mine was a strain NOT a tear. Could have been much worse. Gl Sai! I imagine tears definitely aren't fun what's with all the serious injuries on the forum as of late?!

[Nic Scheelings]

Get a scan, better to know what you are dealing with. ultrasound is cheap and will tell you a lot. As someone who's been through a bicep rupture get it looked at soon, if its a partial tear you may be able to skate by without surgery as Josh has stated. i'm convinced that I partially tore my bicep tendon before having a complete rupture and like an idiot I tried to ignore it, I'm not sure if I would have had to have surgery or not with the partial tear, as I didn't get it examined but i'm pretty sure it was a ticking time bomb and waiting to go.

 

Don't panic tho you can make a full recovery either way

[Joshua Naterman]

A strain IS a tear.

 

Strain literally means "change in structure" and when we say we "pulled" a muscle or "strained" something what we are actually saying is that we tore a little bit of the muscle. It's no big deal when it's minor. When you can't see bruising at all, you've usually got nothing to worry about as long as you take a full 8 week rehab cycle and then take another 4 months of staying sub-maximal. At that point it's been 6 months, you have completely mature muscle once again, and you can go train a bit harder if you like.

 

Failure to go through this complete cycle is the most common cause of repetitive injury.

[alec_ar]

Huh. My bad. Well then I guess I'm assuming it was a low grade one strain, or not even that. Should have seen the doc lols. Anyway, sounds like Sai might have the real deal. Could I ask why you participated in that competition even after you knew you were injured bro? Ouch!

[thenail01]

You can completely rupture your biceps (popeye arm) and it's not a huge deal.  Unless you're an elite level athlete (as in, your livelihood might depend on your athleticism), it's probably not worth getting fixed.  

 

No form of treatment has been shown to be of benefit for biceps tendinopathy/fraying.

[Nic Scheelings]

Depends on where you rupture, rupture at the elbow is indeed a big deal, renders the bicep useless. Rupture at the shoulder generally means the long head which is less serious but you are still gonna have a loss of strength, in the end I would get both fixed if it were me, but at the elbow you must get it fixed if you want any strength in the arm.

[alec_ar]

Yeah what do they call that, the distal biceps tendon? Makes me cringe just thinking about it.

[AlexX]

You can completely rupture your biceps (popeye arm) and it's not a huge deal.  Unless you're an elite level athlete (as in, your livelihood might depend on your athleticism), it's probably not worth getting fixed.  

 

No form of treatment has been shown to be of benefit for biceps tendinopathy/fraying.

I don't see why you need to be an elite level athlete to want full function of all your joints and musculature. I imagine that most people are on here to go as far as possible in their pursuit of athleticism. Not everyone has the genetic potential (or the proper length of time) to be an elite level athlete, why add another handicap to that.  

[Joshua Naterman]

The thing is, you have enough elbow flexion from brachialis and brachioradialis to perform ADLs (acts of dailiy living) like carrying your groceries, cooking, etc. You won't have as much strength, but you'll still be strong enough and functional enough to do a lot of things. Probably including pronated regular grip pull ups, since the biceps don't help very much during those.

 

 

Of course, you usually have the short head and that is the larger and more powerful part.

 

The long head is 20% of total supination strength or so, so even if you lose that, it is kind of irrelevant even for strength training from a function and health perspective.

 

Here's a good study to read. The discussion covers most everything people here want to know.

 

http://www.villageatpelham.com/Physicians/VOS/education-and-research/Documents/Forearm%20supination%20vs%20elbow%20flexion%20strength%20Singleton.pdf

 

 

Now, if you lose the whole thing... well, that's less than 5% of all biceps tendon ruptures according to http://orthopedics.about.com/cs/shouldersurgery/a/bicepsrupture_3.htm

 

Most of the time the distal tear is surgically repaired, because you tend to lose 30-50% of total arm strength if it is not.

 

For more information:

http://orthoinfo.aaos.org/topic.cfm?topic=a00376

 

http://www.orthogate.org/patient-education/elbow/distal-biceps-rupture.html

[thenail01]

Of course if it were me, I'd want it repaired.  It’s not just a simple question of surgically fix it or not.  There are months of rehab after surgery, meaning months of lost training time and now the complications of associated muscle atrophy since you are limiting not just the biceps post-surgically.  There are the complications from the surgery itself.  And there’s the very likely possibility that things don’t return to normal after surgery and strength is not completely regained.  There are economic considerations.  If you have a biceps, it’s probably there for a good reason, true.  Distal biceps rupture are exceedingly rare though perhaps more common in gymnasts, still rare.