Overview
According to the American Academy of Orthopaedic Surgeons, biceps tendon tear at the elbow are rare, occurring in about 3 to 5 patients per 100,000 each year, and most commonly in men. Tears of the biceps tendon are usually caused by a traumatic injury where the elbow is forced straight against resistance and results in significant arm weakness. When the tendon ruptures, there is often a pop at the elbow with severe pain at first. The pain may subside after a week or two, but other symptoms include:
- Swelling in the front of the elbow
- Bruising in elbow and forearm
- Weakness in bending of the elbow
- Weakness in twisting of forearm (supination)
- Bulging in the front part of the arm
- Gap in the front of the elbow due to tendon absence
Bicep Muscle
The biceps muscle helps you bend and rotate your arm. It attaches at the elbow to a small bump on the radius bone called the radial tuberosity.
Anatomy
Located in the front of the upper arm, the biceps muscle is attached to the bones of the shoulder and elbow by tendons. These tendons attach muscles to bones with their strong cords of fibrous tissue. The distal biceps tendon is the tendon at the elbow that attaches to the radius bone called the radial tuberosity near your elbow joint.
There are two types of biceps tendon tears:
- Partial tears – damages the soft tissue and partially severs the tendon
- Complete tears – a complete detachment of the tendon from its attachment point at the bone, the radial tuberosity. A complete tear is most commonly seen where the entire muscle is severed from the bone and pulled toward the shoulder.
Once torn off, the biceps tendon at the elbow will not grow back, preventing rotation of the forearm from palm down to palm up—a motion called supination that is essential for power gripping. The injured arm, without surgical repair, will have about 30-40% decrease in strength. Other arm muscles can compensate for the tendon that is injured, resulting in reasonable function and motion; however, in order to restore your arm strength to near normal levels, Dr. Stowell may suggest surgery to repair the torn tendon. Nonsurgical treatments for patients who may not require full arm function or who cannot make time for post-surgery rehabilitation may be suggested.
Treatment
Physical Examination and Imaging Tests.
Dr. Stowell will examine your elbow and discuss your symptoms. During your physical examination, Dr. Stowell will feel the front of your elbow and look to see if there is a gap in your tendon. He will test your supination forearm strength by having you rotate your forearm with resistance. He will then compare your supination strength to the strength of your uninjured, opposing arm. Dr. Stowell may order imaging tests to help confirm his diagnosis. An X-ray will not show soft tissues like the biceps tendon, but can be useful in ruling out other problems that may be causing elbow pain. If your diagnosis of a distal biceps tendon tear is obvious to Dr. Stowell upon examination, additional imaging such as an MRI may not be necessary. If ordered, an MRI will show Dr. Stowell the free end of your biceps tendon that has recoiled up in your arm. An MRI scan can help Dr. Stowell see both partial and complete tears of your biceps tendon.
Nonsurgical Treatment
The purpose of nonsurgical treatment is to relieve pain and maintain as much arm function as possible. Dr. Stowell may recommend:
- Rest – avoid heavy lifting and overhead activities
- Sling – wearing a sling for a brief time for stability
- Nonsteroidal anti-inflammatory drugs (NSAIDs) – ibuprofen and/or naproxen can help reduce pain and swelling
- Physical Therapy – once your pain is managed, Dr. Stowell may recommend Physical Therapy to help strengthen the surrounding muscles in order for you to maximize movement and function
Surgical Treatment
Surgery for distal biceps tendon tear repair is ideal during the first 2 to 3 weeks after injury. After this time, restoring arm function with surgery is more challenging because the tendon and biceps muscle begin to scar and shorten. Late surgical treatment options exist but are more complicated and generally less successful. Dr. Stowell will discuss the best treatment options for your specific needs.
Dr. Stowell will discuss with you how he will reattach the distal biceps tendon to your forearm bone. A variety of surgical techniques exist for this repair: single incision at the front of the elbow; small incisions at the front and back of the elbow; drilling holes in the radius bone and attaching the tendon with stitches; using anchors or buttons, small metal implants, to attach the tendon to the bone.
Surgical complications are generally rare, but as with any surgery, there are risks which may include:
- Temporary numbness in forearm, wrist, or hand.
- Temporary weakness in forearm, write, or hand.
- New bone may develop around the surgical site, reducing the ability to twist the forearm. Additional surgery may be required.
- Although very uncommon, the tendon may re-rupture even after the repair has fully healed.
Post-surgery, Dr. Stowell may send you home in a cast or splint to limit your mobility along with a treatment plan for your rehabilitation. The biceps tendon takes more than 3 to 4 months to fully heal. Although light activities can resume after surgery, heavy lifting and vigorous activity should be avoided for several months. Resistance exercises with elastic bands will be helpful to regain strength and range of motion. Dr. Stowell may prescribe physical therapy to help you progress. The healing process is slow, but at your final follow-up visit with Dr. Stowell, almost all patients have full range of motion and strength. Your commitment to Dr. Stowell’s rehabilitation plan is significant in restoring your peak potential.