Biceps Tendon Tear at the Elbow
The biceps muscle can be found in the front side of your upper arm. It will help you bend your elbow joint and move your arm. It will also help keep your shoulder stable.
Tendons affix muscle tissue to bones. Your biceps tendons join the biceps muscle to bones in the shoulder and within the elbow. If you tear the biceps tendon at the elbow, you will lose strength in your arm and be struggling to powerfully turn your arm from palm down to palm up.
When torn, the biceps tendon at the elbow won't grow back to the bone tissue and mend. Other arm muscle groups allow it to be possible to bend the elbow joint rather well without the biceps. However, they cannot fulfill all the functions, particularly the movement of turning the forearm from palm down to palm up. This is called supination. Substantial, permanent weakness during supination will take place if this tendon is not surgically repaired.
The biceps has two tendons that join the muscle to the bone tissue in the shoulder and one tendon that affixes at the elbow. The tendon at the elbow is referred to as the distal biceps tendon. It attaches to the radial tuberosity. This is a little bump on one of the bones in your forearm (radius) in the vicinity of your elbow joint.
Biceps tendon rips can be either partial or complete.
Partial tears. These kinds of rips do not entirely sever the tendon.
Total tears. A complete tear will split the tendon into 2 pieces.
In most cases, rips of the distal biceps tendon are total. This means the entire muscle is separated from the bone and pulled toward the shoulder. Distal biceps tendon rupture is equally possible in the dominant and non-dominant arm.
Other arm muscles can substitute for the damaged tendon, usually leading to full motion and reasonable function. Left without surgical repair, however, the wounded arm will have a 30% to 40% decline in strength, primarily in twisting the forearm (supination).
Rupture of the biceps tendon at the elbow is uncommon. It takes place in only one or two people per 100,000 each year, and rarely in women.
The primary cause of a distal biceps tendon tear is an abrupt injury. These tears are not usually connected with other health conditions.
Injuries to the biceps tendon at the elbow commonly take place whenever the elbow is forced straight against resistance. It's less common to injure this tendon whenever the elbow is forcibly bent against a heavy load.
Raising a heavy box is a good example. Perhaps you grab it without knowing how much it weighs. You strain your biceps muscles and tendons attempting to keep your arms bent, but the weight is too much and forces your arms straight. As you struggle, the tension on your biceps grows and the tendon tears from the bone.
Adult males, age 30 years or elder, are most likely to rip the distal biceps tendon.
Added risk factors for distal biceps tendon tear include:
Smoking. Nicotine use can affect nourishment within the tendon.
Corticosteroid medications. Using corticosteroids has been linked to increased muscle and tendon weakness.
There's often a "pop" at the elbow when the tendon ruptures. Pain is severe at first, but may lessen after a week or so. Other warning signs include:
• Swelling right in front of the elbow
• Visible bruising in the elbow and forearm
• Weakness in bending of the elbow
• Weakness in twisting the forearm (supination)
• A bulge in the upper part of the arm created by the recoiled, shortened biceps muscle
• A gap in the front of the elbow created by the absence of the tendon
Medical Record and Physical Assessment
Immediately after talking about your symptoms, your doctor will evaluate the events of the injury to discover how it occurred. While in the physical assessment, your doctor will feel the front of your elbow, trying to find a break in the tendon. He or she will test the supination strength of your forearm by asking you to rotate your forearm against resistance. Your doctor will compare the supination strength to the strength of your opposite, uninjured forearm.
Besides the assessment, your physician might suggest imaging tests to help validate a diagnosis.
X-rays. Although X-rays can't reveal soft tissues like the biceps tendon, they can be useful for ruling out other problems that can cause elbow pain.
Magnetic resonance imaging (MRI). These scans produce better pictures of soft tissues. They can show both partial and complete tears.
Nonsurgical treatment might be considered for patients who are elderly and inactive, or who have medical problems that make them high risk for minor surgery.
Patients must weigh the decision to go ahead with nonsurgical treatment cautiously, simply because restoring arm function with future surgery may not be possible.
The tendon should be repaired during the first two to three weeks following injury. After this time, the tendon and biceps muscle begin to scar and shorten.
While other options are readily available for patients requesting late surgical treatment for this damage, they are more complex and commonly less successful.
Procedure. Physicians use several treatments to reattach the distal biceps tendon to the forearm bone. Some doctors prefer to use two incisions, while others only one incision. There are advantages and disadvantages to each approach.
Sometimes the tendon is attached with stitches through holes drilled in the bone tissue. Other times, small metal implants are used to attach the tendon to the bone.
Make sure you carefully discuss the options available with your doctor.
Complications. Surgical complications are typically rare and temporary. They appear in about six percent to nine percent of patients.
• Numbness and/or weakness in the forearm can occur and in most cases goes away.
• New bone may develop around the site where the tendon is attached to the forearm bone. Although this usually causes little limitation of motion, sometimes it can lessen the ability to twist the forearm. This demands further surgery.
• Rerupture after full healing of the repair is unusual.
Rehabilitation. Immediately after surgery, your arm may be immobilized in a cast or splint.
Your physician will quickly start having you move your arm, usually with the protection of a brace. He or she may suggest physical therapy to help you restore range of motion and strength.
Resistance exercises, such as lightly contracting the biceps or using elastic bands, may be progressively added to your rehabilitation plan.
Be sure to follow your physician's treatment plan. Since the biceps tendon takes 2 to 3 months to fully heal, it is essential to protect the repair by constraining your activities.
Light work activities can begin soon after surgery. But heavy lifting and vigorous activity should be averted for several months.
Even though it is a slow procedure, your dedication to your rehabilitation plan is the most important element in returning to all the activities you enjoy.
Surgical Outcome. Nearly all patients have complete range of motion at the final follow-up doctor visit.
After time, return to heavy activities and jobs involving manual labor is a reasonable expectation.