Do antibiotics increase your chance of suffering a biceps tendon rupture? What are the treatment options for a biceps tendon tear of the elbow or shoulder? I address those concerns in my latest Ask Dr. Geier column.

Donna asks:

My husband had a biceps tendon rupture recently and we think it is related to Levaquin that he has taken for diverticulitis. Have you seen this? How long is he at risk after discontinuing the medicine? There is no surgical repair according to our doctor. Do you recommend any special precautions or exercises? He is doing PT.

Biceps tendon ruptures and antibiotics

First of all, biceps tendon ruptures can occur in adults in their forties, fifties, and sixties without underlying risk factors. Having said that, quinolone antibiotics have been associated with tendon ruptures, such as the patellar tendon, Achilles tendons, and quadriceps tendons. The use of that class of antibiotics, often used for urinary tract infections and a number of other infections, is discouraged among athletes who place a tremendous amount of stress on their tendons and would risk rupture of them. How long a patient would need to be off of the medicines to be back to a baseline risk is debatable, although I would imagine that it really would be base on how long it takes for the drug to be out of the body.

Man with a distal biceps tendon rupture at the elbow

Distal biceps tendon rupture at the elbow

Distal biceps tendon ruptures are difficult problems. Typically patients feel a sharp pain and often a pop with some sort of load on the elbow. Often it occurs lifting an object or trying to catch a falling object. The patient usually notices bruising of the arm and forearm fairly quickly, and over the next few hours or days, he or she notices the biceps becoming more prominent, as the muscle and tendon retract up the arm.

Nonsurgical treatment is appropriate in some patients, especially those who are not very active. While elbow flexion strength decreases, forearm supination strength is often the more limiting problem. Patients complain of weakness with activities such as turning a doorknob or using a screwdriver. Surgical treatment consists of repairing the tendon back down to the bone and holding it in place with one of a number of fixation devices available. Usually surgeons will keep the patient’s arm immobilized for several weeks before allowing gradual range of motion. After motion is restores, biceps strength progresses, but the overall process to complete recovery can take four to six months.

Proximal biceps tendon rupture at the shoulder

Proximal bicep ruptures, where the tendon is torn at the shoulder instead of the elbow, are more often treated nonoperatively. In very athletic people, surgeons often recommend reattaching it. In older, less active patients, treatment is often nonsurgical, and emphasis is placed on regaining motion and strength. Anecdotally, it is said that Denver Broncos quarterback John Elway had a proximal biceps tendon rupture. The story goes that he had been having shoulder pain for years, and when the tendon finally snapped, he felt much better. Reportedly he never had surgery and won two Super Bowls after the injury.

Proximal biceps tendon at the shoulder

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