Biceps Tendon Tears

Biceps Tendon Tears

How do I know I have a Distal Biceps Tear?

Biceps tendon injuries at the elbow occur with lifting heavy objects, more specifically, losing the grip on a heavy object while trying to keep it up.  The tendon usually ruptures when the elbow is losing its “bend” and straightening out as you’re trying to hold something up with the elbow flexed.  Sudden onset of pain in the elbow and forearm often (but not always) coupled with an audible or palpable pop. Within several days bruising develops along the elbow and forearm although the arm remains relatively usable for lighter activities.

How is a distal tear different from a biceps tear at the shoulder?

Distal injuries differ from a biceps injury at the proximal (shoulder) end of the biceps.  Biceps tendon injuries at the shoulder are not as critical as those at the elbow.  Frequently the biceps injuries at the shoulder can be treated nonsurgically or, if surgery is necessary, on a delayed or elective basis.  On the other hand, loss of the biceps at the elbow can lead to significant loss of strength.  The weakness occurs not just with bending at the elbow but also with turning the forearm and palm upwards (think right hand tightening a screw or left hand loosening a screw).  These are also time-sensitive and ideally are repaired within 2-3 weeks of injury for best results.

What is the treatment?

For active individuals, surgical repair of the biceps is recommended since nonsurgical treatment leads to a significant loss of strength.  In certain sedentary people, particularly in the nondominant arm, nonsurgical treatment can be an option as long as the patient understands that some permanent loss of strength will occur.  If the tear is not treated and is beyond 6 weeks from the injury, often a donor graft is required to lengthen the damaged tendon and complete return of strength is more unpredictable.

What type of surgery is performed?

Surgical repair of distal biceps tendon ruptures is an outpatient procedure which takes 45 minutes to an hour to perform.  The tendon is about the size and shape of a USB plug and runs along the front of the elbow before diving deep into the forearm, where it attaches to the radius bone.  Reattachment involves a combination of sutures, tunnels in the bony attachment site and occasionally a metal anchoring device. Recovery involves several days of immobilization followed by gradual resumption of light daily activities with the affected arm as well as physical therapy.  This is a very successful procedure in which most people can return to normal daily activities within several weeks.  However, return to vigorous activities, sports and weightlifting may take 3-4 months.  Recurrent ruptures are quite rare, in fact, it is more likely that the opposite biceps tendon will sustain an injury as opposed to the repaired biceps.

Drs. Bak and Silas have performed several hundred successful biceps repairs and do this on an outpatient basis.  They also have performed multiple reconstructions of the distal biceps using donor ligaments in situations where the patient has had the injury for several months which can make a primary repair unlikely.