Distal biceps tendon injuries

Distal biceps rupture may be either partial or complete. Acute (usually complete) rupture of the distal biceps tendon usually occurs in men in their late 30’s or 40’s. The mechanism is classically described as an excessive eccentric load to the flexed elbow, so carrying heavy objects, lifting weights or occasionally playing sport are the main causes. Patients may hear a popping sound, accompanied by a tearing sensation and pain over the anterior elbow and proximal forearm. They need to discontinue the activity they were doing and will have swelling and bruising developing over the coming hours and days. They will have weakness in bending their arm, as well as pain and weakness in turning their hand palm up. Sometimes patients feel they have just bruised the elbow, and don’t present for many weeks or even months after the event. Some patients may notice the change in the arm contour, as the tendon retracts  and changes the classic biceps appearance.

Overwhelmingly, the literature indicates that these tears do better with operative management. In rare cases isolated rupture of a single head of the biceps tendon occurs and the decision on non-operative or operative management depends on each patient’s circumstance. Partial or attritional tears occur more commonly in older women, where there is some form of tendinosis within the tendon, or some tendon irritation that causes inflammation, pain and swelling. These may not settle with rest, anti-inflammatory medications and paracetamol, as there is sometimes a narrowing of the proximal radio-ulnar space through which the tendon needs to pass.

  • Management

Partial tears: If non-operative management fails, then then tendon and proximal radio-ulnar space needs to be debrided, and remaining frayed ends detached from the insertion. A formal tendon reattachment to the bone is performed using strong thick sutures weaved into the tendon and drilled across the bone, securing them.

Complete tears: Operative management here is similar to partial tears. The tendon is retrieved through a small incision over the anterior elbow, and secured to the bone as above.

Chronic neglected tears: These tears are more complex to fix, as they are often retracted a considerable way proximal to the elbow, and the tendon and muscle are not in a good condition. An interposition graft taken from the hamstrings is often required to reconstitute the tendon attachment. This however does not significantly affect the function of the leg. Most anterior cruciate ligament injuries are fixed using a hamstring graft.

Postoperatively patients are usually in a bandage and sling for comfort, and range of motion exercises of the elbow are encouraged as soon as the pain settles. Depending on the degree of injury, you can expect the arm to return to full range of motion, with strength equal to the opposite arm within 3-4 months following the operation. Some patients experience some numbness over the forearm due a nerve that is within the operative site being irritated during the operation, but this mostly settles within 3-4 months.

Conditions Managed

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