Question
Dr. Leatherman, I had a fall where I caught myself by one arm and twisted to land on a safe ledge. During the twist tearing could be heard in my right arm. Initially it looked like an ice cream scoop had taken a dip out of the lowest part of my bicep. Now, two weeks later, it's not so noticable. The MRI report reads as follows: "There is a full thickness tear involving the biceps tendon. The tear has occurred from the attachment onto the radial tuberosity and the tendon has been retracted proximally by at least 8.4cm. Ihis is associated with marked edema... The remaining tendons are otherwise intact. The remaiining muscles are intact about the elbow.
I've got an appointment with the surgeon tomorrow. I'm 46, have had a few surgeries that have left me in more pain than I was when I had them, none on the arm. The arm is sore from the injury but not significantly so. Is there significant risk with not having the surgery? I am physically active, skydiving, jet ski's, moderate weightlifting. If I skip the surgery when should I start rehab.
Thank you in advance for your assistance. It's tough to find an unbiased opinion.

Answer
Dear Richard,

The bottom line on a full thickness bicep tear is that the only way to repair it is with surgery. From what you have described, it sounds like the tear is in the long head of the bicep.  There is no way to rehabilitate a muscle that has been torn all the way through.  If you had a 50% tear or even a 75% tear it could be rehabbed, but not with full thickness.

Now considering the above, the bicep muscle has two separate heads (long head and short head) that function as a unit, but when one has been torn the other will compensate for it. Conversely, you mentioned the tear is in the tendon, and many times when the tendon has torn, both heads have been torn as well.  If this is the case, surgery is your only option.  If you were a professional athlete, there would be no way that you could perform to your abilities without the surgery, but if only one head has been torn, you can remain physically active, jet ski, skydive, and continue to lift weights. Performance will depend on your level of activity, competition, and intensity, you will likely notice decreases in functional strength and speed.    

This is really a decision that you and the surgeon need to discuss fully to figure out how much you need or want to use the muscle.  There is also a cosmetic implication...you will always have the indentation/bulge of the muscle where it has been displaced.  It will lessen over time as the muscle will atrophy without use and the swelling is reduced, but a slight disfigurement will remain.

Good luck with your decision Richard,
Respectfully,
Dr. J. Shawn Leatherman