The biceps muscle is in the front of your upper arm. It helps you bend your elbow and rotate your forearm. It also helps keep your shoulder stable.
Tendons attach muscles to bones. Your biceps tendons attach the biceps muscle to bones in the shoulder and in the elbow. If you tear the biceps tendon at the elbow, you will lose strength in your arm and be unable to forcefully turn your arm from palm down to palm up.
Once torn, the biceps tendon at the elbow will not grow back to the bone and heal. Other arm muscles make it possible to bend the elbow fairly well without the biceps. However, they cannot fulfill all the functions, especially the motion of rotating the forearm from palm down to palm up. This is called supination. Significant, permanent weakness during supination will occur if this tendon is not surgically repaired.
The biceps has two tendons that attach the muscle to the bone in the shoulder and one tendon that attaches at the elbow. The tendon at the elbow is also called the distal biceps tendon. It attaches to the radial tuberosity. This is a small bump on one of the bones in your forearm (radius) near your elbow joint.
In most cases, tears of the distal biceps tendon are complete. This means that the entire muscle is detached from the bone and pulled toward the shoulder. Distal biceps tendon rupture is equally likely in the dominant and non-dominant arm.
Other arm muscles can substitute for the injured tendon, usually resulting in full motion and reasonable function. Left without surgical repair, however, the injured arm will have a 30% to 40% decrease in strength, mainly in twisting the forearm (supination).
Rupture of the biceps tendon at the elbow is unusual. It occurs in only one to two people per 100,000 each year, and rarely in women.
A distal biceps tendon tear can cause the muscle to ball up near the shoulder. Bruising at the elbow is also common.
There is often a “pop” at the elbow when the tendon ruptures. Pain is severe at first, but may subside after a week or two. Other symptoms include:
- Swelling in the front of the elbow
- Visible bruising in the elbow and forearm
- Weakness in bending of the elbow
- Weakness in twisting the forearm (supination)
- A bulge in the upper part of the arm created by the recoiled, shortened biceps muscle
- A gap in the front of the elbow created by the absence of the tendon
Nonsurgical treatment may be considered for patients who are elderly and inactive, or who have medical problems that make them high-risk for modest surgery.
The tendon should ideally be repaired during the first few weeks after injury. After this time, the tendon and biceps muscle begin to scar and shorten. While other options are available for patients requesting late surgical treatment for this injury, they are more complicated and generally less successful.
Dr. Samimi utilizes a minimally invasive single incision approach to reattach the distal biceps tendon to the forearm bone. This approach allows for a smaller scar and minimizes risk of developing scarring (heterotopic ossification)
The tendon is attached with sutures and through holes drilled in the bone.
Surgical complications are generally rare and temporary. They occur in about 6% to 9% of patients:
- Numbness and/or weakness in the forearm can occur and usually goes away.
- New bone (heterotopic ossification) may develop around the site where the tendon is attached to the forearm bone. While this usually causes little limitation of movement, sometimes it can reduce the ability to twist the forearm. This may require additional surgery.
- Rerupture after full healing of the repair is uncommon.
Right after surgery, your arm may be immobilized in a cast or splint. Soon you will begin moving your arm, often with the protection of a brace. Physical therapy may be prescribed to help regain range of motion and strength.
The biceps tendon typically takes 2 to 3 months to fully heal, therefore, it is important to protect the repair by restricting your activities.
Light work activities can begin soon after surgery. But heavy lifting and vigorous activity should be avoided for several months after the treatment of the biceps tendon tear treatment.