Mr Dimitrios Tsekes: How to avoid a bicep injury in the gym, and how to treat a bicep tendon tear

Mr Dimitrios Tsekes, a leading orthopaedic and upper-limb surgeon at our Shoulder Unit, specialises in elbow and sports injuries. He explains how easy it is to suffer a bicep injury while working out and details what the most common injuries are, their severity, and what you can do to avoid a painful bicep tendon tear.

How easy is it to obtain a bicep injury?

Performing exercises at the gym for biceps strengthening can cause injuries when such exercises are not balanced and coordinated. When applying a sudden and serious load, or in cases of serious or constant overuse, a tendon may wear and eventually tear. As an upper limb specialist, I treat these injuries in my practice daily.

What’s the severity of a biceps injury?

The biceps muscle is located at the front part of our arms. It’s a powerful flexor of our elbow joint and supinator, or rotator, of our forearm when using a screwdriver or turning a key, for example.

The biceps muscle has two tendons, called ‘’heads’’, that attach to the shoulder — the long head attached at the top of the shoulder cup and a short head attached under the collarbone — and one tendon that attaches it to the elbow.

The commonest injuries include tendonitis, which is micro-tears in the tendon from overuse, and tendon tears. A tear can also be complete or partial. A complete tear means the tendon has torn away from the bone. Biceps tendon tears around the shoulder almost exclusively occur in the long head.

In the case of a complete tear of the long head tendon, the short head tendon will allow you to continue using your biceps muscle. However, it can cause cramping and fatigue of the arm that may become worse with time. A biceps tendon tear at the elbow can cause weakness in powerful palm-up activities, like tightening with a screwdriver with the right hand. It can reduce your elbow flexion strength, and you might experience fatigue in repetitive flexion activities or supination exercises.

What can a person do to avoid a torn bicep in the gym?

Take it slowly at first and gradually build up your activity level. Avoid improper posture and ask your coach to teach you the correct techniques for biceps training. Make sure you warm up before starting your exercise, and never forget to stretch the muscles of your arm for a good five minutes before and after exercising. The more repetitions you do and the more force you use, the greater the chances for an injury. You need to stop if you feel any unusual pain.

Exercises that concentrate solely on the biceps can give faster results as far as strength, volume and cosmesis are concerned. However, they place the bicep muscle at greater risk of injury. Dumbbell curls, incline dumbbell curls, EZ-bar preacher curls and concentration curls are good for isolating the biceps but are more likely to cause injuries when not performed appropriately. Barbell curls work on both arms but put extra forces on the biceps, especially the long head.

On the contrary, exercises like hammer curls that utilise biceps and brachialis — another muscle in the front part of our arm — can also improve flexion power and give volume, reducing the risk.

Finally, exercises that apply a steady and constant load on the bicep muscle and focus on the brachialis throughout the range of movement, like standing resistance-band hammer curls or standing cable rope hammer curls, also reduce the chances of injuries.

When should you seek medical help for a bicep muscle tear?

During or after biceps training, if you feel a sharp pain at the shoulder or elbow followed by weakness and trouble rotating your arm from a palm-down to a palm-up position. If that does not improve after a period of rest, cold packs or ice and anti-inflammatory medication, it indicates a significant injury to your biceps.

When you feel a “pop” and a bruise appears on the upper arm or forearm, near the elbow, or you notice a change in the contour of your upper arm — “Popeye muscle” — that usually indicates a bicep tear. In both cases, you should urgently seek an upper limb specialist’s opinion.

What can a patient expect from a torn bicep consultation?

You will be offered both operative and non-operative options. Physiotherapy, in cases of tendonitis and partial tears, can improve the symptoms. In instances of tendonitis without a tear, corticosteroid injections may reduce the inflammation and pain while enhancing tendon healing.

In cases of long head partial tears, both tenotomy — cutting the tendon from its point of insertion on the shoulder cup — or tenodesis — reattaching it on the arm — show good functional results. Tenotomy, however, might result in “Popeye muscle”, reduced supination power, fatigue and cramping of the biceps. Therefore, we usually recommend tenodesis in young, active patients. Surgery to reattach a long head tendon can safely restore your arm strength and function, while a retearing of the repaired tendon is uncommon.

If non-operative treatment for partial rupture of the elbow biceps tendon fails, operative treatment with tendon debridement and reattachment renders good results. In case of a complete tear of the tendon around the elbow, surgery is often recommended, as a lack of operation can cause up to 50% loss of supination and 30% loss of elbow flexion power.

There are different methods to reattach the tendon on the radius, all providing equal results. However, those who decide to have surgery will need to do so quickly because both the long head and the elbow tendon begin to scar one to two weeks after the tear, meaning surgery becomes more difficult and permanent muscle atrophy occurs with time.

What’s the follow-up and aftercare?

It may take up to six weeks for the tendons to heal. It may also take up to three months or more of physical therapy, including range of movement (flexibility) and strengthening exercises for an operated shoulder or elbow to rehabilitate. When it does, patients usually enjoy a full range of motion and near-normal arm strength.

What are the benefits of a patient coming to the Shoulder Unit?

The patient will be seen by a leading orthopaedic Consultant specialised in treating all conditions related to the upper limbs and shoulders. We provide a comprehensive service for all upper-limb injuries, from consultation to examination and expert treatment, and we work closely with our specialist physiotherapists for advanced, convenient and quick rehabilitation.

Make an appointment

We have a team of seven world-leading upper-limb orthopaedic surgeons, including Mr Dimitrios Tsekes, that make up our Shoulder Unit. To book a personalised appointment, you can call us on 020 7806 4004 or email shoulderunit@hje.org.uk

Flexible appointment times are available.