Biceps Tendon Rupture
Other popular names
- Distal Bicep tear
Who does it affect?
The people most likely to get a biceps tendon rupture are strength athletes, bodybuilders and heavy manual workers. Generally, males over the age of 35 years. Unlike other tendon ruptures, steroid use has not been shown to be involved in the rupture of the distal biceps.
Why does it happen?
The biceps muscle is the large muscle in the front of your upper arm. It is the muscle most flexed by strongmen in demonstrating their muscles. The biceps is attached at the top in the shoulder and then below the elbow into the radius bone by a strong tendon.
This strong tendon at the elbow can rupture with a very strong contraction of the biceps muscle. People may feel a pop in the elbow and pain. This usually happens when the tendon is already worn and prone to injury.
After the injury there is usually localised pain at the front of the elbow, with bruising and swelling. The biceps muscle may retract up the upper arm crating a prominent bump, known as the 'Popeye' sign. This is often visibly different to the other biceps when contracting the muscle.
A biceps tendon rupture leads to weakness of the elbow and forearm if not repaired. People have difficulty twisting a screwdriver, turning a key and lifting weights. This is due to 55% reduction in forearm twisting strength (supination power) and 36% reduction in elbow bending strength (flexion power).
Therefore, early surgical repair is required to restore full strength and correct the deformity. Repair should be undertaken within 2-3 weeks of the injury, or as early as possible.
Investigations are normally not necessary as the condition is well known and easy to identify. Ultrasound or MRI scans may be used to examine tissue damage.
There are no non-surgical treatments available. Ice should be used to reduce swelling and a strapping may be used to minimise pain until surgery can be undertaken.
Surgery is carried out as a day case procedure usually either under general anaesthetic and takes about 30-45 minutes
There are many different repair techniques. I generally use a small incision and repair with strong metal button, reattaching the tendon down to the bone. The repair is strong and you can start moving soon after the surgery. However lifting must be avoided for at least 6 weeks after surgery.
A biceps tendon rupture that is over 4 weeks old is often more difficult to repair directly. The tendon is often retracted up the arm and stuck, so a second higher incision may be made to retrieve it. Sometimes a reconstruction with another tendon might be required. In such chronic cases I 'bridge' the repair and reinforce it with either tendon from your thigh (tensor fascia lata) or a tendo-achilles allograft. This is similar to the ligaments used in knee ligament reconstructions.
You can go home soon after the operation. Simple analgesia (pain killers) usually controls the pain and should be started before the anaesthetic has worn off. The dressing will be removed soon after your operation. The wound is cleaned and redressed with a simple dressing. Avoid forced gripping or lifting heavy objects for 2-3 weeks. The sutures are removed at about 2 days.
After the surgery a Plaster of Paris backslab is used to protect the repair for two to three weeks. Following removal of the backslap, physiotherapy will be arranged to help you regain the movement and strength in your arm. It can take up to 6-12 months to regain the full strength of your biceps.
Return to normal routine
Keep the wound dry until the stitches are out at 12 days.
Return to driving:
The hand needs to have full control of the steering wheel and left hand the gear stick. You are advised to avoid driving for approximately 6 weeks after surgery. You will be advised by me about this.
Return to work:
Everyone has different work environments. Returning to heavy manual labour should be prevented for approximately 12 - 16 weeks. Early return to heavy work may cause the tendon to re-rupture. You will be given advice on your own particular situation.
Overall over 95% are happy with the result. However complications can occur.
General risks (less than 1% each):
- Neuroma (nerve pain)
Reflex Sympathetic Dystrophy - RSD (<1% people suffer a reaction to surgery with painful stiff hands, which can occur with any elbow surgery from a minor procedure to a complex reconstruction).
- Nerve damage
- Blood vessel damage
- Re-rupture of the tendon