Distal Biceps Rupture
The biceps muscle is on the front side of the upper arm and gives the arm its characteristic shape. The tendon travels across the front of the elbow and attaches to the top of the radius bone. The biceps primarily functions to turn the palm of the hand upward (supination) but also bends the elbow. The tendon usually tears because of sudden excessive loading.
Most patients are men associated with heavy lifting. Occasionally the patient reports a longer-term problem affecting the arm, which might indicate a more inflammatory, scarred process.
In Outpatients’ Clinic
Your surgeon will arrange an x-ray and examine your arm. There may be bruising and a deformed contracted biceps muscle. When asked to use the muscle it may be painful. The doctor will try to feel the tendon and compare it to the other side. The tear may be partial or complete and if there’s any doubt an ultrasound or MRI scan (FAB view = a special position of the arm) is normally arranged.
It is vital that you are clear about when the injury or rupture occurred. The longer you leave it the more difficult the surgery and the increased risk of significant and limb threatening nerve or vessel damage during surgery. We will not normally offer repair beyond 4 weeks and ideally prefer to perform the surgery in the first week following the injury.
What is the treatment?
You do not need to have the tendon repaired. If you choose not to you will have permanent deformity of the arm with a small contracted biceps. Your elbow flexion/bending strength will usually return to near normal as other muscles can take over. Your ability/strength to turn the palm upward (like using a screw-driver) will be significantly reduced. If you have a partial tear in the tendon, this may recover but sometimes reattaching the tendon is required.
For partial tears, the tendon can be visualised and if less than 50% torn can be reattached with an anchor. If greater than 50%, we complete the tear and repair it fully into the bone. The surgery involves freshening the tendon to healthy tissue and then reinserting it into a tunnel, which we create in the bone where the previous tendon insertion was.
After the surgery
The elbow is placed into a bulky bandage dressing and a sling applied. Very occasionally, a plaster is used for a couple of weeks to protect the repair. You can gently move the elbow from the outset if instructed to do so by your surgeon. DO NOT load the arm for 6 weeks and return to heavy lifting should be delayed for at least three months if not longer.
Mr Sam Vollans
Consultant Orthopaedic Surgeon
I graduated from the University of Leeds and completed my specialist training in Yorkshire. Following this, I undertook further training in both elective and trauma shoulder & elbow surgery in Sheffield with David Stanley, David Potter and Amjid Ali.
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