What is a distal biceps tear?
Elbow injuries can be common among athletes and the active population. A distal biceps tear occurs when the tendon attaching the biceps muscle to the elbow is torn from the radius These types of tears are categorized as either partial or complete. A partial tear does not completely sever the tendon, while a complete tear will sever or “break” the tendon into two pieces. In most cases, a distal biceps rupture is less common compared to ruptures where the top of the biceps connects at the shoulder. Dr. James Mazzara, orthopedic elbow specialist serving Manchester, South Windsor, Rocky Hill, Glastonbury and surrounding Hartford communities has extensive experience in treating a distal biceps tear and returning patients to their normal work and sports activities.
What is the difference between biceps and distal biceps?
The biceps is a muscle located in the front of the arm that goes from the elbow to the shoulder. The point where the muscle attaches to the bone is called a tendon. Within the upper arm, two groups of tendons are associated with the biceps muscle: proximal, or upper biceps tendon and distal, or lower biceps tendon.
The lower or distal biceps tendon is the lower attachment site of the biceps muscle which attaches to a small bump on the radius bone of the forearm. The small bony bump is called the radial tuberosity.
Any type of tendon tear or rupture, rather it be the proximal biceps or the distal biceps is serious and needs to be evaluated by Dr. Mazzara as soon as possible.
What causes a distal biceps tear?
This type of injury occurs primarily in middle-aged men during heavy work or lifting. A small number of women may experience distal biceps tendon tear, but these are typically partial tears. Partial tears of the distal biceps are more difficult to diagnose, but symptoms typically include aching and pain with extension. A distal bicep rupture can happen when, for instance, a box or other heavy item is being lifted with the elbows bent. If the load is heavier than expected, or shifts unexpectedly during the lift, this forces the elbow to straighten at the same moment the biceps muscle is working hard to keep the arm bent. The biceps muscle contracts extra hard to help handle the load and the tension on the muscle increases. The distal biceps tendon can snap or tear away from the radius if the tension-load becomes too heavy.
What are the symptoms of a distal biceps tear?
Distal biceps ruptures are rare, making up only 10% of biceps ruptures. Once a distal biceps tendon has ruptured or torn, symptoms can appear immediately. Symptoms include:
- Initial intense pain followed by a dull ache or throbbing pain. After a few days, the pain may improve considerable causing patients to think that they are getting better
- Bruising and swelling in the biceps area (front of the arm)
- Weakness in the arm
- A loud “pop” at the time of the tear
- Cosmetic change in the normal contour of the upper arm (bulge in the upper arm or a gap in the front of the elbow)
Have you sustained a distal biceps tear?
There are two ways to initiate a consultation with Dr. Mazzara:
You can provide current X-rays and/or MRIs for a clinical case review with Dr. Mazzara.
You can schedule an office consultation with Dr. Mazzara.
How is a distal biceps rupture diagnosed?
An early diagnosis of a distal biceps rupture is best and can lead to better outcomes, especially if surgery is required. During the exam, Dr. Mazzara will take a detailed patient history and perform a thorough exam of the elbow. By feeling the muscle and tendon, he can often tell if the tendon has torn from the bone. An MRI may be used to confirm a diagnosis of partial or complete rupture. If examination does not confirm the diagnosis, Dr. Mazzara may be able to perform an ultrasound in the office during your visit to evaluate the condition of the tendon.
How to treat a distal biceps tear without surgery?
Non-surgical treatment of a distal biceps tear is only appropriate for partial tears and patients who are involved in low demand activities, typically elderly patients. This treatment may include rest, immobilizing the arm and managing pain. Many partial tears will not heal and will lead to continuing aching and discomfort with increased pain when then tendon is under stress. These partial tears will eventually lead to a complete rupture.
What are surgical treatment options for a distal biceps tear?
Patients with an active lifestyle may wish to have surgery for a distal biceps tear so they can regain full arm strength. Dr. Mazzara suggests surgery soon after the distal biceps is injured to avoid tendon retraction (when the tendon retreats further up the arm.) When the tendon recoils from it’s original position in the arm and remains there for a time, surgery becomes more difficult and patient outcomes are not as good as when treatment is sought quickly.
There are several surgical options offered by Dr. Mazzara and the method may be determined by the type of tear. Typically, Dr. Mazzara will perform an arthroscopic, small single incision, repair to reconnect the tendon to its correct location on the bone from where it was torn. In cases where the tendon is severely retracted or scarred, a graft may be needed.
After surgery, patients are immobilized with the use a special range-of-motion brace for 4-6 weeks. Careful elbow motion may begin once the tear has started to heal. Physical therapy will then be used to re-establish motion and prevent stiffness. Strengthening exercises will begin when the distal biceps tear is completely healed and under the direction of Dr. Mazzara. Most patients are able to return to their normal activities 12-16 weeks after the injury.
For more resources on a distal bicep tear, or the treatment options for a distal biceps tendon rupture, please contact Dr. James Mazzara, elbow specialist serving patients living in Manchester, South Windsor, Rocky Hill, Glastonbury and surrounding Hartford Connecticut communities.