Distal Biceps Tendon Tear

biceps tear
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The distal biceps tendon is the tendon that connects the biceps muscle of the arm to the radius bone of the forearm, just below the elbow joint.  Contraction of the biceps muscle pulls the forearm up, causing the bending movement at the elbow joint.  Injuries to the distal biceps tendon occur around the elbow joint.

The most common injury to the distal biceps tendon occurs right where the tendon attaches to the bone.

  Distal biceps tendon tears represent about 10% of all biceps tendon injuries, the other 90% of biceps tendon injuries are to the proximal biceps tendon.  The injury almost always occurs in middle-aged men (over 90%) in their 40s, although it can infrequently occur in women and in other age groups.  The injury typically occurs during a lifting activity that causes an eccentric contraction of the biceps.  Often someone is lifting a heavy object when the object slips, causing the tendon to tear.

Symptoms of a Torn Distal Biceps

People who tear their distal biceps tendon almost always have sudden, immediate pain and know something is wrong.  The most common symptoms of a distal biceps rupture include:

After the acute symptoms of pain, swelling and stiffness have subsided, patients with a torn distal biceps often notice weakness of the biceps.

  Most people expect to  notice this weakness with elbow flexion--bending the elbow joint.  In reality, other muscles can compensate pretty well, causing only a mild loss of strength of elbow flexion.  However, most patients do notice significant weakness in supination of the forearm.  Supination is the motion of twisting the forearm to turn the palm up, such as opening a jar or a doorknob, or twisting a screwdriver.

The diagnosis of a distal biceps rupture is often very clear to your orthopedic surgeon.  The story is often typical, and patients have common examination findings described above.  X-rays are typically normal.  Your surgeon may elect to have an MRI done to confirm the injury and to ensure there is no other damage around the elbow.

Treatment of a Torn Distal Biceps

Non-surgical treatment can be considered in patients who have lower demands in terms of strength needs of their arm.  However, most people who sustain a distal biceps tear are interested in regaining normal function, and the injury is much more common in one's dominant arm.  For these reasons, most patients will choose to pursue surgical repair of their torn biceps tendon.

Surgery is not an emergency, but the torn tendon can retract and the muscle can weaken, so generally your surgeon will proceed with surgical repair within the first 3-4 weeks following the injury.  When surgery is delayed, recovery may be incomplete, and tissue grafts may be needs in order to repair the damaged tendon.

To repair the torn tendon, the biceps must be surgically reattached to the radius bone.  There are many surgical techniques used to repair a distal biceps tendon.  Some surgical techniques use a single incision, others use two incisions.  Some use implants to reattach the torn tendon, others use sutures passed through drill holes made in the bone.  One surgical procedure has not been shown to be consistently better, and any of the commonly performed procedures can effectively repair the torn tendon.

Sources:

Sutton KM, et al. "Surgical Treatment of Distal Biceps Rupture" J Am Acad Orthop Surg March 2010 vol. 18 no. 3 139-148.

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