Tears of the long biceps tendon can be categorized based on their course and cause:

1. Partial tear: The tendon is not completely severed, often leading to mild symptoms.

2. Complete tear: The tendon is completely torn, usually resulting in a sudden loss of function.

3. Traumatic tear: Occurs due to an acute injury, such as a fall or strong tensile load.

4. Degenerative tear: Develops due to age-related wear or chronic overuse.

5. Proximal tears: Affect the attachment of the tendon at the shoulder.

6. Distal tears: Affect the attachment of the tendon at the elbow (less common).

The causes of a rupture of the long biceps tendon are varied and can be divided into acute and chronic factors:

Acute causes:

- Sudden overload, for example when weightlifting or during an abrupt fall.

- Injuries from direct trauma, such as in an accident or collision.

Chronic causes:

- Degenerative changes due to aging or chronic overuse.

- Repeated movements, especially overhead work or throwing motions that strain the tendon.

- Pre-existing damage from inflammation, such as in biceps tendonitis.

The symptoms vary depending on the type and severity of the tendon tear, but often include:

- **Sudden pain:** A sharp pain in the shoulder area with an acute tear.

- **Loss of strength:** Significant weakness in movements involving the biceps muscle, especially when lifting or rotating the arm.

- **Altered contour of the arm:** A visible muscle bulge in the upper arm ("Popeye sign") is typical with a complete tear.

- **Movement restrictions:** Reduced mobility and stability of the shoulder joint.

- **Popping sound:** An audible popping or snapping when the tendon tears.

- **Chronic pain:** Degenerative tears often cause diffuse pain in the shoulder.

The diagnosis is made through a combination of medical history, clinical examination, and imaging techniques:

Medical History:

The doctor inquires about the course of the symptoms, the circumstances of the injury, and possible risk factors such as overuse or pre-existing conditions.

Physical Examination:

Examination of the shoulder for tenderness, movement restrictions, and typical deformities such as the "Popeye sign."

Functional tests to assess the strength and stability of the biceps muscle.

Imaging:

Ultrasound: Visualization of tendon injuries or fluid accumulations.

MRI: Detailed imaging of the tendon and surrounding structures.

X-ray: Exclusion of bony changes or accompanying injuries.

Conservative Therapy

In many cases, especially with partial tears or degenerative tears, non-operative treatment is sufficient:

• Pain therapy:
  • NSAIDs: To relieve pain and inflammation.
• Physiotherapy:
  • Building muscle and improving mobility through targeted exercises.
• Shoulder braces:
  • To stabilize and relieve the joint.
• Injections:
  • Corticosteroids to relieve pain and inflammation.

Surgical Therapy

In cases of complete tears or persistent symptoms, surgery may be necessary:

• Tendon refixation: The tendon is surgically reattached to the bone.
• Tendon transfer: Replacement of the torn tendon with adjacent tissue.
• Minimally invasive techniques: Arthroscopic procedures for quick rehabilitation and minimal tissue damage.

The following measures are suitable for preventing a tear of the long biceps tendon:

1. Avoiding overload: Protecting the shoulder during repeated or intense activities.
2. Regular training: Building strong and flexible shoulder and arm muscles.
3. Warming up before sports: Preparing muscles and tendons for exertion.
4. Minimizing risk factors: Treating pre-existing conditions such as inflammation or poor posture.
5. Ergonomic movements: Avoiding jerky or uncontrolled movements.