What is the Distal Biceps?
The Distal Biceps (biceps muscle), which starts as two separate tendons in the shoulder (long and short head of the biceps tendon), combines in the arm bone (humerus) to form the biceps muscle (biceps). The biceps muscle descends from the arm bone and passes through the elbow joint and attaches to one of the forearm bones (radius) as a single tendon.
The function of the Distal biceps is to flex (flex) the elbow joint and rotate the forearm bones out of the body. (Supination)
Where in the Body Does a Distal Biceps Injury in the Elbow Occur?
It occurs as a result of the separation of the biceps tendon (distal biceps tendon), which extends from the arm bone to the lower side of the elbow joint, from the forearm bones from the place where it attaches to the outer bone (Radius). Sometimes the injury is not the bone, but the tendon itself is torn and damaged.
How Does a Distal Biceps Injury in the Elbow Occur?
Injuries to the biceps tendon at the elbow usually occur when an object is in the hand, while the arm is forced against direct resistance. These tendon injuries are more common when the elbow is kept straight.
Distal biceps rupture can occur when trying to pick up a heavy object such as a suitcase over the locker with the elbow straight, lifting weights from the gym, or punching in a punching bag.
You often try to lift the weight with the elbow joint bent, without being aware of how heavy the object is. In the meantime, the object is very heavy and you force your biceps muscle by straightening your elbow to lift it. But the weight is too much. As you try to lift, the biceps muscle is strained even more and the distal biceps tendon separates from the bone and ruptures.
What Are the Risk Factors for a Distal Biceps Injury at the Elbow?
Known risk factors are cortisol (steroid) use and smoking.
What Are the Symptoms of a Distal Biceps Injury in the Elbow?
When the tendon ruptures, a popping sound is heard in front of the elbow joint, which can be heard by the patient and bystanders.
The pain is very intense at first, but decreases as time goes on.
Swelling in front of elbow joint and forearm.
Bruising in the front of the elbow joint and on the forearm.
Difficulty in bending the elbow joint, feeling loss of strength.
Difficulty in turning the forearm, weakness.
Growth and swelling of the distal biceps(when the biceps tendon is torn from the elbow joint, the muscle gathers on the arm bone)
A gap where the biceps tendon is located in front of the elbow joint.
How is a Distal Biceps Injury Diagnosed at the Elbow?
Distal biceps injuries are diagnosed after a detailed history and physical examination. MR imaging is used to understand exactly where the tear is, whether it is separated from the bone or whether the tendon is torn, whether it is a complete tear or a partial tear, and if it is a complete tear, where the tendon is.
How to Treat Distal Biceps Injury in Elbow?
In order for the arm to return to its former strength, the injured biceps tendon must be reattached to the bone.
When is Distal Biceps Injury Surgery in the Elbow Performed?
It is necessary to perform the repair surgery in the first 2-3 weeks. After this time, it may be impossible to suture the biceps tendon to the bone, as the biceps muscle shrinks and shortens. Instead of repair surgery, this time, reconstruction (taking a tendon from another part of the body, passing it through the muscle and connecting it to the bone) surgery is required.
After reconstruction surgeries, like repair surgery, it is difficult to get excellent results and longer post-operative rehabilitation is required.
How is Distal Biceps Injury Repair Surgery Performed in the Elbow?
The distal biceps tendon is found by entering from the front of the elbow over the rupture of the distal biceps tendon. Then, the place where the tendon ruptured (radius, one of the bones in the forearm) is reached. This area of the bone is prepared and a hole is opened by carving with a special drill to insert the tendon into the bone. The tendons are knitted with stitches and sutured, these threads are passed through a special metal button. The metal button is placed behind the bone, the threads are stretched and the tendon is inserted into the broken bone and fixed with 1 screw.
How Is the Process After the Distal Biceps Injury Surgery in the Elbow?
For the first 2 weeks, the elbow is not moved, most of the time a splint or arm sling is used for this. Healing of the surgical site takes an average of 10-14 days. During this period, it is recommended to perform movements of the fingers, hand, wrist (except for the rotation movement) and shoulder joint.
After the second week of the operation, it is aimed to regain the movement of the elbow joint. The important thing here is not to put a load on the biceps tendon until the end of the 1st month. After 1 month, the tendon begins to be strengthened gradually.
Almost all of the patients return to the sports they did in the 3rd month of their surgery.
