Biceps Rupture

The biceps muscle is located in front of your upper arm. It helps in bending your elbow as well as in rotational movements of your forearm. Also, it helps to maintain stability in the shoulder joint. The biceps muscle has three tendons, two attach it to the bones in the shoulder (long and short heads) and one attaches at the elbow (distal biceps). If one of the biceps tendons ruptures at the shoulder, usually the other tendon is able to compensate and no surgery is needed. A cosmetic bump will be seen in the mid arm (popeye deformity) but usually full function returns without surgery. If a partial biceps tendon tear at the shoulder continues to cause pain, arthroscopic surgery to release the tendon or fix it in another location may be considered.

The biceps tendon at the elbow is called the distal biceps tendon and if there is a tear in this tendon you will have pain and weakness moving your arm from the palm-down to palm-up position. Once the distal biceps tendon is torn, it retracts and cannot regrow back to the bone and heal by itself. Permanent weakness during rotatory movements of the forearm may occur if the tendon is not repaired surgically.

Biceps tendon tears can be complete or partial. In partial biceps tendon tears, the tendon does not tear completely. Complete tendon tears will rupture the tendon into two parts. Tears of the distal biceps tendon are usually complete tears and the muscle gets separated from the bone. They most often result from a sudden injury or lifting a heavy object.

The most common symptom is a sudden, severe pain in the upper arm or at the elbow. You may feel a "pop" at the elbow when the tendon tears. Other symptoms include swelling, visible bruising, weakness in the elbow, trouble turning your arm from a palm up to a palm down position, and a gap in the front of the elbow caused by absence of the tendon. A bulge may also appear in your arm caused by the recoiled, shortened biceps muscle.

Distal biceps tendon ruptures are usually diagnosed based on your symptoms, medical history, and physical examination. During the physical examination, your doctor will look for a gap in the tendon by palpating the front part of your elbow. Your doctor will diagnose a partial tear by asking you to bend your arm and tighten the biceps muscle. You may have pain if there is a partial tear. X-rays may be taken to rule out other conditions causing elbow pain. Using an MRI scan, your doctor can see whether tear is partial or complete.

There are several procedures to accomplish reattachment of the distal biceps tendon to the forearm bone. Some techniques require two incisions while in others one incision may be sufficient. In some cases, the tendon is reattached using stitches passed through holes drilled in the bone. Sometimes, a small metal implant may be used to attach the tendon.

Surgical technique

During distal biceps tendon repair, your surgeon makes an incision over the upper forearm where the biceps muscle attaches to the radius bone. The torn biceps tendon is brought up through the incision. Then, the radius bone is prepared for tendon reattachment and to promote healing. One or two suture anchors will be inserted into the bone. These serve as anchorage for the tendon. The sutures from the suture anchors are passed through the tendon in a particular interlocking manner so as to ensure a strong tendon repair.

After the repair is complete, a splint is used for 10 days, and then a hinged elbow brace will protect your elbow until the tendon is fully healed. Return to full activities usually takes 5-6 months, and strength and endurance will improve up to 1 year.