Distal Biceps Repair

What is it?

Distal biceps repair is a surgical treatment for patients who have sustained a distal biceps rupture at the elbow. Patients can sustain a distal biceps rupture from an forceful eccentric load placed on their arm. Typically this results from a attempting to lift a very heavy object or attempting to brace a heavy object from falling. It is much more common in male patients of middle age. Rupture of the distal biceps can result in permanent loss of rotational strength of the forearm and some loss of flexion strength at the elbow.

How do I know if I need surgery?

The decision to pursue surgery for this injury is an individualized one. It depends on many factors including, age, activity level, handedness, job requirements, chronicity of the tear, and overall health. Patients who choose to treat their distal biceps rupture non-operatively can expect improvement of their pain but permanent loss of some elbow strength and fatigue with certain repetitive elbow movements. For most healthy and active patients, surgical repair is generally recommended but many patients are able to live relatively normal lives with a chronic unrepaired tear.

What are the expected results?

Patients who undergo a successful repair without any post-operative complications can expect to have close to normal function of the elbow in the long term. Strength should be expected to return to > 90% of normal in most patients. Many patients return to their pre-injury level of function without difficulty.

What are the risks?

Major medical complications are rare during the peri-operative period of distal biceps repair. Besides routine surgical risks, below are some of the more common risks of surgery:

Re-rupture: Re-rupture of the tendon is uncommon but can occur. That is why we place you into a brace during the first 6 weeks and place limitations on your function up to 3 months after surgery.

Nerve Injury: In particular, one nerve (the lateral antebrachial cutaneous nerve), which gives you sensation in the forearm, is in the operative field. It must be identified and protected in every case. Some patients may have temporary numbness or nerve irritation that resolves in the majority of patients. Other nerves can be stretched or injuried, but this is less common with a two-incision approach.

Heterotopic Bone Formation: Rarely, excess bone can form around the elbow following tendon repair. We given patients an anti-inflammatory (indomethacin) to prevent this bone from forming.

How do I know if I have a distal biceps rupture?

Patients who have sustained a distal biceps rupture will typically feel a pop in their elbow from the injury. Their biceps muscle may ball up towards the shoulder and there will be some pain and swelling in the elbow crease. Often times, patients will develop bruising near the tear. Flexion strength may be slightly weaker, but rotation of the forearm (supination), such as the motion to turn a screw driver, is usually the most profound weakness present.

Usually, physical exam is all that is needed to diagnose a distal biceps tear. Sometimes an MRI is needed to distinguish partial tears from complete tears. If you suspect that you may have a distal biceps tear, it is important for you to seek evaluation by an orthopedic surgeon within a few days since there is a time sensitivity to repairing the tendon if warranted.

How is it performed?

During surgery, the torn tendon end is identified and then reattached to the bicipital tuberosity on the radius of the forearm. There are two general approaches to achieving this, a one-incision technique and a two-incision technique. It is our preference to perform a two-incision technique because we beleive that it allows for better anatomic repair of the tendon, and as a result, better functional strength in the long-term.

For the two-incision technique, a small incision is made in the elbow crease to identify the torn tendon end. A secondary incision is made on the outside of the forearm through which the tendon is reattached to a trough created in the attachment site of the tendon. The tendon edge is sewn back down to the bone with sutures.

How long is the recovery?

The procedure itself is performed as an outpatient and you will be discharged to home the same day as the surgery. You be in a splint. Within the first couple weeks of surgery, you will be placed into a hinged elbow brace. There will be progressive exercises to slowly regain your motion without stressing the repair. At 6 weeks post-op, most patients are back to near normal elbow motion. At this point, the elbow undergoes progressive strengthening with release back to full activity occuring at 3 months post-op. For some patients a full recovery can take >4 months.