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What it is

The biceps muscle lies in the front of your upper arm between your shoulder and elbow. It attaches to your forearm with a single tendon called the distal biceps tendon. Tears of this tendon usually occur in a traumatic manner with a sudden pop or tear felt while doing manual labor or lifting heavy weight. Like many tendon problems, it is more common in men in their 40’s to 60’s. But, it can also occur in women and younger people. Distal biceps tendon tears are more common in smokers due to the detrimental effects of smoking on the body’s ability to heal itself and keep tendons strong. The distal biceps tendon usually tears directly off of the bone when it ruptures.

Symptoms

Patients usually feel, and maybe even hear, a pop or tear in the front of the elbow. They typically get some bruising over their elbow and forearm, but this can sometimes take a few days to show up. In some cases, the biceps muscle will retract up towards the shoulder. Patients will notice weakness in elbow bending (flexion) as well as forearm rotation (supination) because those are the two main functions of the biceps muscle. If the biceps is not repaired, patients will experience a permanent loss of about 30% flexion strength, and about 50% supination strength.

Non-operative Treatment

In older patients who have lower activity levels or are unable to have surgery for another reason, non-operative treatment may be appropriate. Pain will usually cease after 4-6 weeks and elbow range of motion is expected to return to normal in about the same amount of time. Minimal effect on simple activities of daily living is expected despite the lost strength.

Operative Treatment

For the majority of patients, surgery is recommended to reattach the tendon back down to the bone. This is most easily done in the first 1-2 weeks after rupture but can still be performed, in most cases, up to 6 weeks after injury. After six weeks, the muscle can get scarred and the tendon can start to degenerate, which many prevent reattachment. The operation to reattach the biceps tendon is done under general anesthesia as an outpatient and takes about an hour. It is performed through a single small incision in the front of the elbow. The tendon is reattached to the bone with sutures, a metal anchor, and a screw.

Post-operative Recovery

After the biceps tendon is reattached, it must heal and scar back down to the bone. This process takes about 3 months and lifting with the operative arm is limited to 5-10 pounds during this time. No splinting is required after surgery and patients typically stop using a sling after 1-2 days. Simple daily tasks can be resumed immediately and patients can return to light duty work as soon as they feel comfortable. The elbow is usually stiff for a few weeks but most patients have full range of motion in their elbow by one month after surgery. Although strength is expected to return back to normal, it can sometimes take up to a year for patients to achieve this.


If you think you have suffered a tear of your biceps tendon, call Dr. Murch immediately at 715-847-2382 so that you can get in for an evaluation.


 

All Images Copyright American Society for Surgery of the Hand