The biceps is one of the most well known muscles in the body. It has two heads (long and short) that differentiate and attach at different points around the shoulder. Distally (closer to the elbow), the two heads converge to make one tendon that inserts onto the radius (a bone in the forearm).
Distal biceps ruptures are almost exclusively an injury of the dominant elbow (86%) of men (93%). Smoking and anabolic steroids are risk factors for injury, but most people who present with this problem do neither.
The injury occurs when the elbow is forced into extension while the elbow is actively being flexed. Imagine a person helping to carry a large refrigerator with his elbow slightly bent when all of a sudden he loses control and the full force of the fridge forces his elbow straight against his will. Symptoms commonly include an audible pop, obvious deformity, and bruising. Pain is usually immediate but subsides quickly.
Someone with a concern for this injury should be seen URGENTLY by an orthopedic surgeon, because if surgery is necessary it is best done within 1-2 weeks. Presenting to a physician should not be delayed because of lack of pain, because most people have minimal pain, but if not treated early the weakness may be permanent. Patients will generally lose 50% supination strength (strength needed to tighten a screwdriver) and 30% elbow flexion strength.
X-rays are done to rule-out a fracture. A good clinical exam can usually diagnose a tear, but if there is a question of whether there is a full thickness or partial tear an MRI is very useful.
TREATMENT:
NONOPERATIVE – Nonoperative management is reserved for the medically unfit and partial tears involving <50% of the tendon
OPERATIVE – Outpatient (same-day) surgery is indicated in almost all cases of healthy, active individuals with this injury in order to restore strength in supination and flexion and avoid permanent deformity.
Preferred technique: I prefer to repair the tendon within a week with a small 1-2” incision using a button and a screw.
FAQs:
- Is it an outpatient surgery? – YES
- What is recovery like? – 2 weeks in a splint followed by 4 weeks in an adjustable brace. Strengthening begins at 3 months.
- Will I be able to return to my activities and sports? – Yes. My goal is to get you back to all of your regular sports and activities without any restriction.