About Distal Biceps Tendonitis and Ruptures
Patients with distal biceps tendonitis experience pain in the anterior of the elbow. They often describe it as deep and a bit towards the outer part of the proximal forearm. They often have a history of an event that started the pain. This injury usually occurs from reaching to lift something that is heavier than expected with the palms facing up and elbow and shoulder outstretched. Patients may even feel a “pop”, which may be indicative of a complete or high-grade partial distal biceps rupture.
Cause and Anatomy of Distal Biceps Tendonitis and Ruptures
Distal biceps injuries are generally caused by eccentric loading of the muscle. This occurs most frequently with the arm outstretched, palm facing up, and a sudden or unexpectedly heavy weight. Imagine reaching out to open up a heavy garage door or trying to carry a very heavy piece of furniture. Although the biceps consist of two muscles and tendons around its origin from the shoulder/chest region, they coalesce to form a single distal biceps tendon that attaches on the radial tuberosity of the elbow/proximal forearm area.
Diagnosis of Distal Biceps Tendonitis and Ruptures
The diagnosis of the distal biceps injury is typically made based on the history and examination performed by the doctor. You may experience pain when asked to push up against resistance with the arm outstretched and palm facing up or doing a biceps curl motion against resistance. In case of a rupture, there may be bruising in the area of the forearm and/or elbow. You may notice asymmetry when inspecting the biceps muscle. The muscle bulk may be retracted proximally and your doctor may be able to palpate loss of the distal biceps tendon. An MRI is the test of choice to confirm the pathology.
What Are My Options?
Distal biceps tendonitis and mild, low-grade tears can be successfully treated non-surgically. Treatment modalities include rest, activity modification/avoidance, physical therapy, anti-inflammatories, ice, and injections. It is important not to continue to push through the pain with activity as it will almost always make the condition worse in the case of distal biceps injuries.
Complete ruptures of the distal biceps lead to roughly 30% reduction in flexion/supination strength. Therefore, most patients will choose to have these repaired surgically. Partial tears and chronic tendonitis that have not responded to non-surgical options for treatment can be repaired by detaching and reattaching the tendon. The surgery is typically performed as a day surgery at an ambulatory surgery center under regional and IV anesthesia. Depending on surgeon preference and chronicity of the injury you may have 1 or 2 incisions. The distal biceps can be reattached to the bone with a variety of methods but the most common is by using a button through a drill-hole in the bone with a heavy suture attached.
Post-operative recovery involves wearing a sling, and in some cases, a plaster splint or brace may be necessary for added protection. Supervised physical therapy is necessary to regain full function.
Frequently Asked Questions
What are the potential complications?
Complications of distal biceps repair surgery include elbow stiffness, numbness along the lateral forearm, re-rupture, infection, and nerve damage.
Will I be able to resume pre-injury level of activity after surgery?
Yes. Most patients make a full recovery.
How long is the recovery after distal biceps repair surgery?
It takes 3 months for the tendon to heal to the bone biologically. You will be limited in activities during this time and primarily focus on regaining motion. Most patients regain elbow motion by 6 weeks after surgery. You can start strengthening after the 3 month healing time. Overall recovery is 4-6 months.