Anatomy

Biceps tendon tears can be either partial or complete.

  • Partial tears. These tears damage the soft tissue but do not completely sever the tendon.
  • Complete tears. A complete tear will detach the tendon completely from its attachment point at the bone.

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.

Symptoms

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

Doctor Examination

Physical Examination

After discussing your symptoms and how the injury occurred, your doctor will examine your elbow. During the physical examination, your doctor will feel the front of your elbow, looking for a gap in the tendon. He or she will test the supination strength of your forearm by asking you to rotate your forearm against resistance. Your doctor will compare the supination strength to the strength of your opposite, uninjured forearm.

 

Imaging Tests

In addition to the examination, your doctor may recommend imaging tests to help confirm a diagnosis.

  • X-rays. Although x-rays cannot show soft tissues like the biceps tendon, they can be useful in ruling out other problems that can cause elbow pain.
  • Ultrasound. This imaging technique can show the free end of the biceps tendon that has recoiled up in the arm.
  • Magnetic resonance imaging (MRI). These scans create better images of soft tissues. They can show both partial and complete tears of the biceps tendon.

Treatment

Surgery to reattach the tendon to the bone is necessary to regain full arm strength and function.

Nonsurgical treatment may be considered if you are older and less active, or if the injury occurred in your nondominant arm and you can tolerate not having full arm function. Nonsurgical treatment may also be an option for people who have medical problems that put them at higher risk for complications during surgery.

Nonsurgical Treatment

Nonsurgical treatment options focus on relieving pain and maintaining as much arm function as possible. Treatment recommendations may include:

  • Rest. Avoid heavy lifting and overhead activities to relieve pain and limit swelling. Your doctor may recommend using a sling for a brief time.
  • Nonsteroidal anti-inflammatory medications. Drugs like ibuprofen and naproxen reduce pain and swelling.
  • Physical therapy. After the pain decreases, your doctor may recommend rehabilitation exercises to strengthen surrounding muscles in order to restore as much movement as possible.

Surgical Treatment

Surgery to repair the tendon should be performed during the first 2 to 3 weeks after injury. After this time, the tendon and biceps muscle begin to scar and shorten, and restoring arm function with surgery may not be possible. While other options are available for patients requesting late surgical treatment for this injury, they are more complicated and generally less successful.

Procedure

There are several different procedures to reattach the distal biceps tendon to the forearm bone. I prefer a single incision.

The tendon tear is identified and sutured. We then attach the tendon back to the radial tuberosity.

Rehabilitation

Right after surgery, your arm will be in a splint. At the first follow up visit we will transition to a hinged elbow brace.  This allows for controlled motion at the elbow.  Over the first 6wks we will work on gaining full range of motion. 

Light work activities can begin soon after surgery. Heavy lifting and vigorous activity should be avoided for several months. Strength training will begin at 12wks postoperatively. 

Surgical Outcome

Most patients have full range of motion and strength at the completion of the rehab program.

The road to recovery begins now.