Anatomy
Description
Cause
The main cause of a distal biceps tendon tear is a sudden injury. These tears are rarely associated with other medical conditions.
Injury
Lifting a heavy box is a good example. Perhaps you grab it without realizing how much it weighs. You strain your biceps muscles and tendons trying to keep your arms bent, but the weight is too much and forces your arms straight. As you struggle, the stress on your biceps increases and the tendon tears away from the bone.
Risk Factors
Additional risk factors for distal biceps tendon tear include:
Smoking. Nicotine use can affect nutrition in the tendon.
Corticosteroid medications. Using corticosteroids has been linked to increased muscle and tendon weakness.
Symptoms
- 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
Medical History and Physical Examination
In addition to the examination, your doctor may recommend imaging tests to help confirm a diagnosis.
Imaging Tests
Magnetic resonance imaging (MRI). These scans create better images of soft tissues. They can show both partial and complete tears.
Treatment
Nonsurgical Treatment
Patients must weigh the decision to proceed with nonsurgical treatment carefully, because restoring arm function with later surgery may not be possible.
The tendon should be repaired during the first 2 to 3 weeks after injury. After this time, the tendon and biceps muscle begin to scar and shorten.
While other options are available for patients requesting late surgical treatment for this injury, they are more complicated and generally less successful.
Surgical Treatment
Sometimes the tendon is attached with stitches through holes drilled in the bone. Other times, small metal implants are used to attach the tendon to the bone.
Be sure to carefully discuss the options available with your doctor.
Complications. Surgical complications are generally rare and temporary. They occur in about 6% to 9% of patients.
- Numbness and/or weakness in the forearm can occur and usually goes away.
- New bone may develop around the site where the tendon is attached to the forearm bone. While this usually causes little limitation of movement, sometimes it can reduce the ability to twist the forearm. This requires additional surgery.
- Rerupture after full healing of the repair is uncommon.
Rehabilitation. Right after surgery, your arm may be immobilized in a cast or splint.
Your doctor will soon begin having you move your arm, often with the protection of a brace. He or she may prescribe physical therapy to help you regain range of motion and strength.
Resistance exercises, such as lightly contracting the biceps or using elastic bands, may be gradually added to your rehabilitation plan.
Be sure to follow your doctor’s treatment plan. Since the biceps tendon takes 2 to 3 months to fully heal, it is important to protect the repair by restricting your activities.
Light work activities can begin soon after surgery. But heavy lifting and vigorous activity should be avoided for several months.
Although it is a slow process, your commitment to your rehabilitation plan is the most important factor in returning to all the activities you enjoy.
Surgical Outcome. Almost all patients have full range of motion at the final follow-up doctor visit.
After time, return to heavy activities and jobs involving manual labor is a reasonable expectation.
From the AAOS.org
Thanks,
JTM, MD