Distal biceps tear

Distal biceps tear

The biceps muscle is located on the front of the arm and inserts on the radial tuberosity below the elbow joint. Its main function is supination (palm up) of the forearm but it helps with elbow flexion as well. Distal biceps rupture is caused by a sudden injury during lifting a heavy load or sudden straightening of the elbow to reach something.

How does the distal biceps tendon tear?

There are several ways in which a distal biceps tendon tear can happen:

  1. Sudden Forceful Movement: A sudden and forceful movement can lead to a distal biceps tendon tear. This often occurs during activities that require heavy lifting, such as lifting a heavy object or performing a forceful pulling motion.
  2. Eccentric Loading: Eccentric loading refers to the lengthening of a muscle while it is under tension. When the biceps muscle is forcefully lengthened during activities such as lowering a heavy weight or resisting a sudden extension of the elbow, the distal biceps tendon can be overloaded and torn.
  3. Aging and Degeneration: Over time, the tendons in the body can naturally degenerate and weaken. This degeneration can make the distal biceps tendon more susceptible to tearing, even with relatively minor or routine activities.

How do I know that my biceps is torn?

Signs and symptoms of a distal biceps tendon tear may include:

  • Sudden and severe pain near the elbow
  • A “pop” sound or sensation at the time of injury
  • Swelling and bruising around the elbow
  • Weakness in forearm and elbow strength, particularly with twisting the forearm or bending the elbow
  • Visible bulging or retraction of the biceps muscle near the elbow (Popeye sign)

Do I need an MRI?

While a physical examination and medical history review are typically the first steps in diagnosing a distal biceps tendon tear, an MRI (Magnetic Resonance Imaging) scan can provide valuable information to confirm the diagnosis and assess the extent of the injury.

Risk factors that may increase the likelihood of a distal biceps tendon tear include:

  • Age: Tendon degeneration becomes more common as individuals age, making older individuals more prone to this injury.
  • Strength Training: Participating in activities or sports that involve repetitive or heavy lifting, such as weightlifting, increases the risk of a distal biceps tendon tear.
  • Smoking: Smoking has been associated with a higher risk of tendon injuries due to its negative effects on tendon healing and overall tissue health.
  • Steroid Use: The use of anabolic steroids can weaken tendons and increase the risk of injury.

Do I need to have my tendon repaired?

Whether or not you need to have your distal biceps tendon repaired depends on various factors, including the severity of the tear, your level of symptoms, your functional needs, and your personal preferences. It is important to consult with a healthcare professional, particularly an orthopedic specialist, to assess your specific condition and recommend the most appropriate treatment plan for you.

In general, there are two main treatment options for a distal biceps tendon tear:

  1. Non-Surgical Treatment: For partial tears or tears that do not significantly impact your daily activities or strength, non-surgical treatment may be considered. This approach typically involves rest, activity modification, pain management, and physical therapy. Non-surgical treatment may be suitable for individuals who are not highly active and do not require full strength and function of the affected arm, or for those who have underlying health conditions that make surgery risky.
  2. Surgical Repair: Surgical repair is often recommended for individuals who require full strength and function of the affected arm, particularly for those who are physically active or involved in sports or occupations that demand upper limb strength. Surgery involves reattaching the torn distal biceps tendon to the bone using various techniques, and it aims to restore normal tendon function and prevent long-term weakness.

Factors that may influence the decision to undergo surgical repair include:

  • Severity of the Tear: Complete tears or significant tears that result in functional limitations and weakness may require surgical intervention.
  • Age and Activity Level: Younger and more active individuals may be more likely to opt for surgical repair to regain full strength and function.
  • Occupation or Sports Involvement: If your work or activities require significant use of the affected arm, surgery may be recommended to ensure optimal recovery and return to full activity.

You can discuss your options by booking a consultation with Mr Negru who can evaluate your specific situation, conduct a thorough examination, and consider your personal goals and preferences. He will be able to provide you with the best advice and guide you towards the most suitable treatment approach for your distal biceps tendon tear.

How is my distal biceps repaired?

The surgical repair of a distal biceps tendon tear typically involves reattaching the torn tendon to the bone using various techniques. Two commonly used techniques for distal biceps tendon repair:

  • Anatomic Repair: This technique aims to restore the torn tendon to its original attachment site on the radial tuberosity, which is a bony prominence on the radius bone near the elbow. An incision is made over the front of the elbow to access the torn tendon and the radial tuberosity and the tendon is then reattached to the radial tuberosity using an endobutton.
  • Non-Anatomic Repair: In some cases, an anatomic repair may not be possible due to factors such as chronic tears, poor tendon quality, or other anatomical considerations. In such situations, a non-anatomic repair technique may be used. This involves reattaching the torn tendon to a different location on the forearm bone, typically using a tendon graft or another tendon in the area. The non-anatomic repair technique aims to restore the function of the biceps muscle but may result in slightly different mechanics compared to an anatomic repair.

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If you suffer with an Upper Limb problem, you are in the right place.

I am an Orthopaedic Surgeon sub-specialized in the diagnostic and treatment of Upper Limb problems. Pain in the shoulder, elbow or hand can have a significant impact upon daily living and can restrict your ability to perform exercise and sports.
My goal is to provide a personalized expert opinion to ensure that you can benefit from the best treatment in the shortest time possible. Useful information related to Upper Limb problems can be found browsing this website. My practice is based in Gibraltar and Marbella (Spain) but I do occasional work in Bucharest and London. Read more

Mr. Marius Negru

Shoulder and Elbow Specialist


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