DISTAL BICEPS TENDON TEAR/RUPTURE SURGERY
What Is a Distal Biceps Tendon and What Does It Do?
First, we would like to clarify the correct vernacular of this tendon is the Biceps Tendon not Bicep Tendon. Your biceps muscle, which is one of your front humerus (upper arm bone) muscles, consists of a couple of muscle heads or bellies that have different shoulder attachments. You'll find these attachments at your humerus's "proximal" end. At your other muscle's end, close to your elbow, your biceps two heads come together forming a single distal biceps tendon.
Found at your humerus's "distal" end, this tendon inserts into the bone of your radius, which is one of your forearm's two bones. Through this radius distal attachment, your biceps engage in both elbow supination and flexion. Supination is where you turn your forearm to a "palm up" position from a "palm down" position, like when you're using a screwdriver to tighten a screw.
What Is a Distal Biceps Tendon Rupture/Tear?
When you have an unexpected force applied to the muscle of your bicep, like when you attempt to catch a person falling or catch something in general, a rupture commonly occurs. Typically, a rupture happens when you have your elbow flexed. Some individuals might hear or feel a "pop" when their tendon becomes separated from their bone.
What Are the Common Causes of a Distal Biceps Tendon Tear/Rupture?
Tendon tendonosis, also spelled tendinosis, can cause a sharp or dull pain in the tendon area in your forearm past the front of your elbow or it can be painless. Sometimes, tendonosis can cause complete tendon rupture or partial tendon tears. One of the few potential causes of elbow pain is biceps tendonosis. You can experience pain in this area from other causes that aren't related to tendon health.
Biceps tendon rupture or tear frequently occurs without any type of warning. It usually happens when you lift a heavy object, like furniture. The object will slip and as you're trying to hold on, the object forcefully straightens your elbow due to its weight.
Any tendon can be affected by bicep tendonitis. This term implies you have tendon inflammation. Often, this is because of using your tendon in a way that causes it to become inflamed. With your biceps tendon, it's always lifting activity that causes the problem, particularly when you're repeating the lifting activities.
What Are the Symptoms of a Distal Biceps Tendon Tear/Rupture?
With a distal biceps rupture or tear, you might experience symptoms such as:
- Weakness in the arm affected when you twist or bend your elbow
- Swelling, pain and/or bruising of your elbow in the front
- Asymmetry in your bicep muscle
- Seeing your biceps muscle belly pulling up towards your shoulder and/or inability to feel your tendon
- A sudden pop, giving away or snap of your elbow
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Can a Distal Biceps Tendon Tear/Rupture Heal on its Own?
Once you tear your biceps tendon at your elbow, it won't heal or grow back to your bone. It's still possible for you to bend your elbow relatively well without your biceps tendon because of your other arm muscles. But, they can't fulfill all your elbow's functions, particularly the motion that rotates your forearm to palm up from palm down.
o bring the strength of your arm to near-normal levels, you may require surgery for repairing the torn tendon. But, nonsurgical treatment may be a reasonable option for you if you don't require complete arm function.
How Do I Get a Distal Biceps Tendon Tear/Rupture Diagnosed?
To diagnose a distal biceps tendon rupture or tear, there are several things you'll need.
After talking with your doctor about your symptoms and how you got the injury, your physician will give you an elbow exam. During this exam, they'll feel your elbow at the front and look for a gap in your tendon. They'll test your forearm's supination strength by having you rotate the forearm against resistance. They'll then compare your supination strength to that of your uninjured, opposite forearm.
Along with the exam, the physician might suggest imaging tests to help with diagnosing your condition.
Some imaging tests may include:
- X-rays: While x-rays can't show your biceps tendon or other soft tissues, they could be helpful to rule out other issues that could be causing your elbow pain.
- Magnetic resonance imaging (MRI): An MRI scan will create better images of your soft tissues and show both complete and partial tears of your biceps tendon.
- Ultrasound: An ultrasound can show your biceps tendon's free end that has recoiled up in your arm.
What Are the Treatment Options for a Distal Biceps Tendon Tear/Rupture?
There are both nonsurgical and surgical treatments.
Most physicians prefer treating distal biceps tendon tears or ruptures without surgery. You'll likely receive nonsurgical treatment if you require minimal arm strength and do minimal activities. You'll only receive nonsurgical treatment if you're not having any issues with arm:
- Mild deformity
If you're an older person who can handle the loss of strength or if your injury occurred in your non-dominant arm, your physician might decide you don't require surgery.
Not having surgery frequently leads to substantial loss of strength. Elbow flexion is somewhat impacted, but supination can be extremely impacted. A distal biceps rupture that's not repaired decreases supination strength.
If your physician decides to perform elbow surgery, they'll perform the distal biceps tendon tear surgery as an outpatient surgery under general or regional anesthesia. Your surgery will likely take a couple of hours. After your procedure, the doctor will place your arm in a splint for a few days to allow your wound to heal and immobilize your elbow. You'll perform gentle hand, wrist, and shoulder exercises during this time.
You'll begin early range of motion within a few days following your procedure depending on the extent and type of your reconstruction. You'll be able to take the splint off and use a range of motion brace for avoiding stiffness in your elbow. It's especially important you achieve elbow extension to fully straighten your elbow.
What's Involved in Distal Biceps Tendon Tear/Rupture Surgery?
Physicians use a few procedures for reattaching the distal biceps tendon to the bone of the forearm. Some physicians prefer using a couple incisions - others like one. Each approach has its own advantages and disadvantages. In some cases, the doctor will attach the tendon with stitches through holes they drill in the bone. In other cases, they'll use small metal implants for attaching the tendon to the bone.
Be sure to discuss the choices carefully with your doctor.
What Is the Recovery Time for Distal Bicep Tendon Tear/Rupture Surgery?
Some steps in recovery include:
When your doctor treats a ruptured biceps tendon nonsurgically, you might have to avoid heavy arm activity for a few weeks. As the swelling and pain resolve, it will be safe for you to start performing regular activities.
If your tendon is torn only partially, your recovery may take longer. Patients typically need to rest their elbow by using a protective sling or splint. As your symptoms ease, you'll typically begin a physical or occupational therapist-supervised carefully progressed rehab program. You may require a couple of months of therapy.
Your rehabilitation will take longer following distal biceps tendon rupture surgery. Right after your procedure, the surgeon might cast your elbow. Or they might decide to use a special range-of-motion brace. After you begin therapy, your first several physical therapy sessions might involve electrical stimulation and ice treatments for helping control swelling and pain following surgery.
You'll slowly begin exercises for improving movement in your:
You'll avoid biceps muscle exercises for around six weeks following your surgery.
How Soon Can I Return to Work After a Distal Biceps Tendon Tear/Rupture Repair?
Rehab will typically last for a couple of months. It takes around three to four months to heal your biceps muscle. You might have the ability to do simpler daily activities in a couple of weeks as long as you're not using your injured arm. Most individuals are able to return to a desk job within a week or two.
What Is the Average Cost for a Distal Biceps Tendon Tear/Rupture Repair?
According to MDsave, a distal biceps tendon repair costs between $7,874 and $12,118. If you don't have insurance or if you're on a high deductible health plan, you'll need to shop around to compare prices. Contact your insurance company to see if and how they cover this procedure.
What Pain Meds Are Prescribed for a Distal Biceps Tendon Tear/Rupture Repair?
Your doctor may prescribe a non-operative, PT treatment program for helping to reduce pain and maintain the full motion of your elbow. You may be prescribed oral nonsteroidal anti-inflammatory medicines, like ibuprofen. Following your initial injury, once your pain has decreased and you have good elbow motion, your treatment plan will likely then move to strengthen the muscles located about your elbow.
Contact Coastal Orthopedics
Contact Coastal Orthopedics to schedule an appointment today for distal biceps tendon tear/rupture repair. We're located on the beautiful Texas Gulf Coast. We understand injuries occur, but you don't have to let them keep you from living an active lifestyle. Whether you fish, play sports, surf, hunt or engage in other activities, we're committed to helping you get back to your active lifestyle.