What is it?
The biceps muscle functions to bend the elbow and rotate the forearm. The end of the muscle, the distal biceps tendon, attaches onto a bone in the forearm (the radius). Distal biceps ruptures are caused by a sudden injury to the elbow, often when lifting heavy objects. This can cause the elbow to be forced straight while the biceps is activated, causing it to tear.
WHAT ARE SIGNS AND SYMPTOMS OF A DISTAL BICEPS TENDON RUPTURE?
Common symptoms of distal biceps tendon ruptures include:
• Sudden pop in the elbow
• Bruising and swelling of the elbow
• A bulge in the upper arm
• Difficulty bending the elbow or rotating the forearm
Diagnosis
In the office, a complete history and physical exam is obtained. Careful measurements of range of motion and strength are recorded. The hook test, a specific examination to detect the biceps tendon, is performed to confirm the injury. Diagnostic imaging, such as X-rays and MRI, is not necessary to confirm the diagnosis.
Treatment
Surgical treatment of distal biceps rupture is recommended in patients who wish to regain arm function and strength. Distal biceps repair is performed by reattaching the tendon back to the bone with a metallic button. This is typically done in an outpatient setting under regional anesthesia, allowing patients to return home the same day. In conjunction with supervised physical therapy, distal biceps repair has been shown to successfully alleviate pain and improve strength.
RECOVERY
Following surgery, patients are immobilized in a splint for one week and then transitioned into a brace for 6-8 weeks. Physical therapy begins around 1-2 weeks after surgery. Range of motion is initiated at this time, followed by strengthening at 12 weeks. Patients generally return to activities at about 5-6 months postoperatively.
DISTAL BICEPS REPAIR
The following animation demonstrates a typical repair of the distal biceps tendon. A small incision is made over the forearm and the torn tendon is identified and sutured. The sutures are then loaded into a button. A small socket is then created over the radius (forearm bone) and the button is inserted and secured onto the bone. The tendon is then docked into the socket by pulling on the sutures. A screw can also be placed to further augment the repair.