Distal biceps tendon repair

Heavy lifting?

Lifting weights in the gym, renovating the house or carrying furniture? A biceps tendon rupture can happen without warning and is usually the result of a sudden injury. It is rare, but in some other cases, a biceps tendon tear can be caused by a degenerative process.

At Schoen Clinic we have many years of experience in the treatment of all aspects of arm, elbow and shoulder conditions. We will help you to relieve your pain with a treatment plan specifically designed for you.

Why is the biceps muscle important?

The biceps muscle is the muscle on the front of your upper arm and is connected to the shoulder and elbow bones by two tendons. Tendons are strong fibrous tissues which attach the muscles in your body to the bones. The tendon which attaches the biceps muscle to the elbow is called the distal biceps tendon. The biceps muscle is important as it has two essential functions; it bends (flexes) the elbow joint and rotates the forearm to a palm up position. If the biceps tendon ruptures, you will have a permanent reduction in strength as the tendon does not grow back to the bone. In which case, surgical intervention will be required to restore functionality and strength.

Symptoms of a distal biceps tendon problem

At the time of the injury it has been reported that there is often a “pop”, with a sudden, severe pain at the elbow. This pain does usually subside as the injury settles but other symptoms can also help to identify an injury to the tendon.
  • Bruising in the elbow
  • Swelling and inflammation in the elbow
  • Weakness bending or twisting the elbow
  • A visible bulge appearing in the upper arm
  • Pain and stiffness around the upper arm which can severely affect your quality of life

Causes: How do distal biceps tendon problems develop?

An injury to the distal biceps tendon can be a partial rupture, but in most cases you will see a complete rupture. A rupture of the tendon most often occurs when the elbow is being pulled into a straightened (extended) position while it is actively trying to do the opposite. Common causes include lifting weights/objects that are too heavy or one-arm water skiing.

Often there is a degenerative process, such as tendinosis, that affects the tendon and makes it more vulnerable to injury. People living sedentary lives, or those who are less physically active are also more prone to tendon injury when subjected to bearing the weight of a heavy load. Smoking has also been linked to this form of injury as nicotine can have an impact on tendon quality. During a sudden, forceful forearm flexion, you can experience a stabbing pain with a snapping sensation followed by bruising soon after. In cases of a complete rupture, it is possible for the biceps tendon to retract towards the shoulder, potentially causing a noticeable cosmetic deformity in the upper arm.

Diagnostics: How we identify a distal biceps tendon problem?

A clinical diagnosis is usually straightforward, in some cases X-rays may show a fracture of the tendon ridge (radial tuberosity). Ultrasound or MRI scanning may be used to determine the level of retraction of the tendon and fatty degeneration of the muscle.

Restoring your range of motion

Conservative management in sedentary patients is a viable option, but surgical repair, especially in acute conditions, is often preferred. It involves reattachment of the tendon to the radius bone. There are different techniques depending on the situation, but most often stitches are put through the distal biceps tendon and then pulled through a suture anchor or device positioned in the radius bone to re-join the tendon to its original location. This will allow the tendon to heal back to the bone.

Medications and physiotherapy

Non-surgical treatment methods most often centre around pain management and maintaining arm function. Pain and anti-inflammatory medications are helpful for reducing pain and swelling to tackle the immediate symptoms. Combined with physical therapy, it is possible to strengthen the surrounding muscles in the arm, but without surgical intervention to treat to the ruptured tendon, there will be a permanent and significant reduction in arm strength and range of motion.

Surgical intervention

In physically active patients or those presenting with an injury in their dominant arm, it is essential to treat the condition as early as possible with surgical intervention. After 2-3 weeks of the injury, the biceps muscle and tendon can begin to shorten and scar, which can be seen when the biceps retract towards the shoulder. If this is the case and the condition has progressed beyond this point, it may not be possible to restore function to the arm with surgical repair. Surgical treatment methods after this time can be more complicated and potentially less successful.

Surgical intervention is typically carried out through an open incision, where the surgeon focuses on repairing the tendon at its attachment site, which will allow it to heal back to the bone. The tendon is held in place with suture anchors (small metal implants) or with stitches that attach the tendon to the radius bone through small, drilled holes. Alternatively, to an open procedure, two smaller incisions can be made, one on the front of the elbow and another at the back. This again will have the same focus of restoring the ‘natural’ structure of the tendon.

Your specialist will guide you through the appropriate treatment options for your condition and advise on the best route of action going forward.

Aftercare

After surgery you will be required to use a brace or a back slab for a period of time and complete a comprehensive rehabilitation programme, that might last 3-4 months in total. Your therapist will guide you through this process and make adjustments that are necessary to your individual needs and situation.

In some cases, a full repair might not be possible and in these cases soft tissue graft implants might be needed to reconstruct the retracted tendon.

You will see your consultant two weeks after surgery and then your physiotherapist. Light work at a desk can start between 2-3 weeks after surgery. Driving will be possible 4-5 weeks after surgery. After 16 weeks you should be able to return to sport specific training.

Distal biceps tendon repair: Our specialists

Our specialist Consultant Orthopaedic Surgeons diagnose and treat all upper limb conditions including the shoulder and elbow. With leaders in the field of orthopaedics and sports injury medicine, you are in the best hands possible to treat your injury.

Mr Giuseppe Sforza

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Orthopaedic Surgeon - Hand & Wrist

Consultant Orthopaedic Surgeon - Shoulder & Elbow

Consultant Orthopaedic Surgeon
MD MCh(Orth)
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Mr Ian Bacarese-Hamilton

Schoen Clinic Orthopaedic and Spinal Hospital London

Head of Department - International

Head of Department - Leg Lengthening

Consultant Orthopaedic Surgeon & Trauma Surgeon
FRCS(Orth)
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Mr Adrian Carlos

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Orthopaedic Surgeon - Hand & Wrist

Consultant Orthopaedic Surgeon - Shoulder & Elbow

Consultant Orthopaedic Surgeon

MB ChB MSc(SurgSci) PgD(Orth) FRCS(Tr&Orth)
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Mr Livio Di Mascio

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Orthopaedic Surgeon - Hand & Wrist

Consultant Orthopaedic Surgeon - Shoulder & Elbow

Consultant Orthopaedic Surgeon
MBBS FRCS Ed (Tr&Orth)
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Mr Dimitrios Karadaglis

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Orthopaedic Surgeon - Hand & Wrist

Consultant Orthopaedic Surgeon - Shoulder & Elbow

Consultant Orthopaedic Surgeon
MRCS, MSc, Dip Orth, FRCS(Tr&Orth)
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Distal biceps tendon repair: Our specialised hospital

Schoen Clinic Orthopaedic and Spinal Hospital is based in the heart of London and is home to some of the finest experts in sports injury treatment. With every aspect of your patient journey all under one roof, a multidisciplinary team of experts at your disposal and quality care you will want to tell your friends about, there is no better place to go to resolve your condition.

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Authors, 09.06.2020