A distal biceps tendon rupture is a complete tear of the tendon of the biceps muscle from its attachment at the elbow. The biceps tendon attaches to the radius bone in the forearm and is important for bending the elbow and forcefully rotating the forearm into a palm-up position.
Surgery is usually required within three weeks of injury to reattach the tendon to the bone and optimize recovery of strength and function.
What Is Tunnelless Distal Biceps Tendon Repair?
Surgical treatment of a distal biceps tendon rupture involves retrieving the torn tendon and reattaching it to the radius bone near the elbow.
The procedure is generally recommended for athletic and active individuals because an unrepaired rupture can result in weakness, particularly when rotating the forearm into a palm-up position. Active individuals may also experience chronic biceps discomfort with use if the tendon is not repaired.
Causes and Risk Factors
A distal biceps tendon rupture may occur from:
- A sudden force that straightens the elbow while the biceps is contracted and the elbow is bent
Risk factors include:
- Contact sports
- Throwing sports
- Gymnastics
- Weightlifting
- Bodybuilding
- Heavy labor
- Poor physical conditioning, including strength and flexibility
- Inadequate warm-up before activity
- Anabolic steroid use
Symptoms
Common signs and symptoms of a distal biceps tendon rupture include:
- Pain, tenderness, swelling, warmth, or redness at the elbow, usually in the front
- Pain that worsens with elbow use, particularly when rotating the forearm into a palm-up position against resistance
- Pain when straightening the elbow
- A visible or palpable bulge in the upper arm as the muscle retracts
- Bruising in the elbow or forearm that may develop after 24 hours
- Limited elbow motion
- Weakness with elbow bending during activities such as lifting or carrying
- Weakness with forearm rotation, such as when using a screwdriver
Treatment
Treatment generally requires surgery within three weeks of injury to reattach the tendon to the bone.
The weakness that results without surgery may be acceptable for older, sedentary individuals but may be less acceptable for athletic and active individuals. Active individuals may also experience chronic biceps discomfort with use if the tendon is not repaired.
Surgical treatment involves retrieving the torn tendon and sewing it back to the bone.
After surgery:
- The elbow is protected in a splint or brace for approximately six weeks
- Physical therapy is used for approximately three to four months to restore elbow and forearm motion and strength
Nonsteroidal anti-inflammatory medications such as aspirin or ibuprofen, or other minor pain relievers such as acetaminophen, may sometimes be recommended as directed by a physician.
Pain medication is usually prescribed after surgery.
Cold may be used after the injury to reduce pain, swelling, and inflammation.
Recovery and Outcomes
Surgery is usually performed within three weeks of injury to optimize recovery of strength and function and help prevent later pain.
Approximately four to six months of rehabilitation are generally required before returning to sports or heavy lifting.
With appropriate rehabilitation, full strength and the majority of muscle bulk can usually be recovered.
Potential complications include:
- Weakness with elbow bending and forearm rotation, particularly without surgical repair
- Prolonged pain or disability without repair
- Re-rupture after surgery
- Infection
- Bleeding
- Nerve injury, particularly involving sensation along the outer forearm
- Heterotopic ossification, or abnormal bone formation in soft tissues
- Elbow or forearm rotational stiffness or loss of motion
- Persistent weakness with elbow bending or forearm rotation
When to See Dr. Chudik
If you experience sudden pain in the front of the elbow, bruising, a visible change in the shape of the biceps, or weakness with lifting or rotating the forearm into a palm-up position, schedule an evaluation with Dr. Chudik.
Call 630-324-0402, request an appointment online, or email contactus@chudikmd.com.