The upper extremity (arm) was the most common body part injured in workplace accidents last year.
And injuries to the biceps, including ruptured biceps tendons, are some of the most common work-related upper arm injuries.
This article discusses the biceps muscles and tendons, common injuries to these structures, and what to consider when deciding the settlement value of a torn biceps injury in workers compensation.
The biceps is a large muscle on the front of your upper arm between the elbow and the shoulder. It crosses both these joints.
Your biceps is a two-headed muscle: the long head is on the arm’s lateral (outside) side, and the short head is on the medial (inside) side. Both heads join in the middle of your upper arm, forming a single muscle mass.
Three tendons attach the biceps muscle to bones in the shoulder and elbow.
Two of these biceps tendons attach the muscle to the shoulder joint. The long head attaches to the glenoid at the top of the shoulder socket, while the short head attaches to the coracoid process, seen as a bump on the shoulder blade. Together, these tendons are known as the proximal biceps tendons.
The third tendon – the distal biceps tendon – attaches the muscle to the elbow.
Although a workplace accident typically involves a tear of only one biceps tendon, it is possible to rupture more than one in the same traumatic incident.
Your biceps help you perform various job tasks and complete activities of daily living (ADLs) like dressing, bathing, cooking, cleaning, and driving.
An injury to the biceps tendons or muscles may limit your ability to bend the elbow toward the shoulder or rotate your forearm.
In turn, the work-related biceps tear may restrict these functions:
A biceps tendon tear is either complete or partial.
Total biceps tendon ruptures are more common than partial biceps tendon tears.
In addition, biceps ruptures occurring between the tendon and the bone (avulsion) are more common than ruptures between the tendon and the biceps muscle.
Specific traumatic incidents cause most biceps tendon tears, increasing the chance that you will qualify for workers compensation benefits like lifetime medical treatment, wage loss payments (temporary total disability), and compensation for permanent loss of use (PPD benefits).
For example, lifting a heavy weight with your elbow bent or landing on an outstretched arm to brace against a fall may cause a biceps injury
Many of the biceps injury claims we prosecute under workers compensation laws involve employees who fall into one or more of these categories:
Diagnosing a biceps tendon tear starts with the doctor taking your history and performing a physical examination in the clinic.
You will likely feel or hear a pop or tear in your upper arm or shoulder, followed by sudden pain. Sometimes the pain extends downward into the forearm.
This pain may worsen in the hours and days following the injury, and weakness or an inability to use the arm and hand may develop.
In addition, your upper arm may swell, show bruising, or have a “Popeye muscle” deformity when you bend the elbow. This term refers to a lump in the arm that appears out of place due to a tendon tear, particularly when compared to the opposite, uninjured arm.
During the clinical examination, your doctor may perform Yergason’s and Speed’s tests to assess for biceps tendon ruptures or inflammation.
Yergason’s Test involves rotating your forearm away from your body while rotating the palm of your hand upward. A biceps injury is likely if you have pain during this movement and your doctor feels a click in the bicipital groove where the long head of the biceps tendon and the transverse humeral ligament pass.
Speed’s Test involves raising your arm toward the ceiling with your palm up without bending your elbow. If this move causes pain, you likely have a biceps tendon tear, biceps tendinitis, or a SLAP tear.
Diagnostic tests like MRIs or CT scans are usually unnecessary to diagnose complete biceps tendon tears. Your doctor, however, will likely refer you for imaging of the elbow or shoulder to confirm the diagnosis and see if you suffered additional damage to the shoulder (including a torn rotator cuff or SLAP tear) or elbow. Of the available tests, MRI is the most helpful for a soft tissue injury like a ruptured biceps tendon.
In my experience, the average workers compensation settlement for a biceps tendon tear is $50,000 to $115,000 or more.
The higher end of the range applies to biceps tendon tears with rotator cuff injuries.
Workers compensation settlement amounts vary widely depending on multiple factors.
When analyzing the settlement value of your biceps tendon tear case, I recommend reviewing these items.
As discussed above, most biceps injuries result from a single trauma.
You may, however, want to ask your treating orthopedic doctor to write a disability letter addressing causation, particularly if the insurer argues that you had pre-existing biceps tendonitis (inflammation of the tendon). The literature suggests that many injured employees who suffer a biceps tendon rupture while lifting a heavy load at work have some degree of degenerative disease, which the insurer will likely use to try to beat your claim.
If you cannot prove causation, your claim has no value.
Many injured workers suffer a torn biceps tendon and torn rotator cuff in the same industrial accident. Indeed, biceps tendon tears are commonly associated with subscapularis tears. The subscapularis is a large muscle that forms the rotator cuff.
Your claim is more valuable if you tore the rotator cuff and biceps tendon in the same occupational accident.
Further, I recommend that you ask your doctor to evaluate your shoulder and neck (cervical spine) if you have pain in the upper arm. Many injured employees discover they suffered a neck injury after treatment for the biceps tendon or rotator cuff tear fails. By then, the statute of limitations to add injured body parts to your claim may have expired.
Though proximal biceps tendon tears are more common, distal biceps tendon ruptures are more disabling because they result in the total loss of biceps muscle function. A distal biceps tear, therefore, will likely have a longer disability duration.
Receiving timely medical care for a torn biceps tendon is crucial to healing and regaining arm function.
Unfortunately, medical treatment denials are a common occurrence in workers comp.
The longer it takes to receive medical care, the more likely you are to have complications from the torn biceps tendon, including the development of a frozen shoulder or complex regional pain syndrome (CRPS).
These complications and extended periods of disability increase the settlement value for a torn bicep.
Some biceps tendon tears are treated conservatively with rest, activity modifications, ice, physical therapy, and pain medication. Indeed, minor tears may heal without surgical intervention because the tendon will reattach itself.
Your physician, however, may recommend surgery, especially if a rotator cuff tear accompanies the biceps tendon rupture, you have a complete tear, or the distal tendon ruptured.
Biceps tear surgeries are usually done arthroscopically and include tenotomy and tenodesis.
The surgery aims to attach the torn biceps tendon back to the shoulder or the elbow and repair the structures that support the bicipital groove.
The goal of rehabilitation after a biceps injury is to regain range of motion and arm strength.
Biceps tendon ruptures can lead to a frozen shoulder (adhesive capsulitis), nerve compression, biceps tendonitis, shoulder impingement syndrome, and overuse injuries involving the healthy arm (which may be covered under the compensable consequence doctrine).
Once you reach maximum medical improvement (MMI) for the biceps injury, your treating workers comp doctor will prescribe a functional capacity evaluation (FCE) with a permanent impairment rating.
This rating quantifies any permanent arm use loss due to the tendon tear.
The higher the impairment rating, the more money you may receive in PPD benefits or settlement.
In my experience, a biceps tendon tear often receives a permanent impairment rating from five percent to 15% under the American Medical Association’s (AMA’s) Guides to the Evaluation of Permanent Impairment.
Biceps tendon tears requiring surgery can lead to permanent disability from jobs classified as medium, heavy, or very heavy by the Dictionary of Occupational Titles.
Therefore, if your biceps injury occurred in a physically demanding job, you may suffer extensive wage loss while you find a new career. And your new job may pay less than your pre-injury work, increasing the settlement value of the biceps tendon tear case.
In addition, your doctor may disable you from all work for several weeks or months, even if you have a sedentary (seated) job requiring light physical exertion, particularly if you need biceps tendon surgery. This period of total disability may be followed by a release to light duty, during which you may qualify for income replacement benefits.
Our top-rated personal injury lawyers have successfully resolved many biceps tear cases through workers compensation hearings and settlements.
Contact us today to see how we can help.