A biceps tendon tear or rupture is a severe injury that occurs when the tendon of the biceps muscle, located at the lower part of the upper arm, detaches from the elbow joint.
This injury often results from sudden and forceful loading or trauma, significantly affecting the strength and mobility of the arm. It is more common in men and typically happens during heavy lifting, sports activities, or falls.
Symptoms include sudden and severe pain, swelling and bruising around the elbow, weakness in the arm, and deformation of the biceps muscle. Treatment for a distal biceps tendon rupture involves surgical repair.
What Is the Biceps Muscle?
The biceps muscle is a prominent muscle located in the front of the upper arm. It plays a vital role in elbow flexion (bending the elbow) and forearm supination (rotating the palm upward).
The muscle consists of two heads: the long head and the short head, both of which attach to the shoulder. The distal biceps tendon connects the biceps muscle to the elbow joint, specifically at the radius bone in the forearm.
Where Does a Distal Biceps Injury Occur?
A distal biceps injury occurs when the tendon of the biceps muscle, extending from the upper arm to the lower side of the elbow joint, detaches from its attachment point on the outer forearm bone (radius). In some cases, the tear does not occur at the bone but within the tendon itself, leading to significant damage.
How Does a Distal Biceps Injury Happen?
Distal biceps tendon tears typically occur when the arm is subjected to excessive resistance while holding an object. These injuries are more common when the elbow is in an extended position.
Examples include:
Trying to lift a heavy object (e.g., a suitcase) from above shoulder height with a straight elbow.
Lifting weights in the gym.
Striking a punching bag during training.
Often, individuals are unaware of the object's weight and attempt to lift it with a bent elbow. As they struggle, they straighten the elbow and overuse the biceps muscle, placing excessive strain on the tendon. If the load exceeds the tendon’s capacity, the distal biceps tendon detaches from the bone, resulting in a rupture.
What Are the Risk Factors for Distal Biceps Injuries?
Known risk factors include:
Corticosteroid (steroid) use
Smoking
What Are the Symptoms of a Distal Biceps Tendon Tear?
When the tendon ruptures, patients often hear a "popping" sound at the front of the elbow, which may also be heard by those nearby.
Symptoms include:
Severe pain initially, which decreases over time.
Swelling in the front of the elbow and forearm.
Bruising around the elbow and forearm.
Difficulty bending the elbow and noticeable loss of strength.
Weakness when rotating the forearm (supination).
Visible swelling of the biceps muscle (the muscle bunches up toward the upper arm as the tendon detaches from the elbow).
A noticeable gap where the biceps tendon used to be at the front of the elbow.
How Is a Distal Biceps Injury Diagnosed?
A detailed medical history and physical examination are typically sufficient to diagnose a distal biceps injury. Imaging techniques such as MRI are used to determine the exact location of the tear, whether the tendon has detached from the bone, or if the tear is partial or complete.
MRI also helps identify the position of the retracted tendon in cases of complete rupture.
How Is a Distal Biceps Tendon Tear Treated?
To restore the arm's original strength and functionality, the injured biceps tendon must be reattached to the bone.
When Should Surgery Be Performed for a Distal Biceps Rupture?
Surgical repair should ideally be performed within the first 2-3 weeks after the injury. Beyond this timeframe, the biceps muscle shortens and contracts, making it nearly impossible to reattach the tendon directly to the bone. In such cases, a reconstruction procedure is required, where a tendon is harvested from another part of the body and used to reattach the muscle to the bone.
Reconstruction surgeries typically do not yield results as favorable as repair surgeries and require a longer rehabilitation period post-surgery.
How Is Surgery Performed for a Distal Biceps Rupture?
Distal biceps tendon repair involves reattaching the torn tendon to its original attachment point on the radius. Advanced surgical techniques and specialized tools are used to ensure a strong and stable repair.
The surgical repair of a distal biceps tendon rupture involves accessing the tendon through an incision at the front of the elbow. The torn tendon is identified, and the attachment site on the radius (one of the forearm bones) is prepared.
The bone is drilled using a specialized tool to create a tunnel where the tendon will be reattached. The tendon is sutured using durable stitches, and the sutures are passed through a specialized metallic button.
The metallic button is secured behind the bone, and the sutures are tightened to pull the tendon into the drilled bone tunnel. The tendon is then fixed in place using a single screw to ensure stability.
You can watch a distal biceps repair surgery performed by Dr. Utku Erdem Özer by clicking this link: [https://www.youtube.com/watch?v=B0GFINR9PvM&pp=ygUmYmljZXBzIHJlcGFpciBzdXJnZXJ5IHV0a3UgZXJkZW0gw7Z6ZXI%3D].
How Long Does Biceps Tendon Surgery Take?
Biceps tendon surgery typically takes 1 to 2 hours. However, the duration may vary depending on the severity of the tear and the patient’s overall health condition. During the procedure, the torn tendon is surgically reattached to the bone, ensuring proper functionality and stability.
What Is the Recovery Process After Distal Biceps Surgery?
First Two Weeks:
The elbow is immobilized using a splint or sling.
The surgical site heals within 10-14 days.
Gentle movements of the fingers, hand, wrist (excluding rotational movements), and shoulder are encouraged to prevent stiffness.
After Two Weeks:
Elbow joint mobility exercises begin to restore movement.
It is critical to avoid placing any load on the biceps tendon during the first month.
After One Month:
Gradual strengthening of the tendon begins.
After Three Months:
Most patients can return to their sports or regular activities.
How to Prevent Biceps Tendon Tears?
Biceps tendon tears can be prevented by adopting simple precautions, including regular stretching and strengthening exercises to maintain tendon health. Avoiding overloading and sudden, forceful movements is also crucial.
Prevention Tips:
Exercise: Incorporate regular stretching and strengthening exercises into your routine.
Technique: Use proper lifting techniques and body mechanics.
Rest: Ensure adequate rest and recovery periods to avoid overuse injuries.
Conclusion
A biceps tendon rupture occurs when the tendon of the biceps muscle, which crosses the elbow joint, detaches from the elbow. This condition typically results from sudden and forceful loading or trauma and significantly impacts arm strength and mobility.
More common in men, this injury often occurs during heavy lifting, sports activities, or falls. Symptoms include sudden severe pain, swelling and bruising around the elbow, weakness in the arm, and deformity of the biceps muscle.
Treatment usually involves surgical reattachment of the tendon to the bone. Surgery performed within the first 2-3 weeks yields the best outcomes, as delayed repairs may require more complex reconstruction procedures.
Post-surgery, the elbow is immobilized for the first two weeks, and most patients can return to sports by the third month. Risk factors include corticosteroid use and smoking.
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