Bicep Tendon Rupture
The biceps is a muscle located at the front of the upper arm spanning from the shoulder to the elbow. Towards the elbow, the muscle becomes a tendon which then attaches to the Radius, one of the forearm bones. Most people mistakenly think the Biceps main function is to flex the elbow, however, the main function of the Biceps is actually to supinate the forearm (rotate the forearm so that the palm faces the sky). The Brachialis muscle is actually the main flexor of the elbow, while the Biceps muscle secondarily helps this action as well.
Distal biceps ruptures usually occur from lifting an unusually heavy object or from sudden extension of the flexed elbow. This can commonly occur from bicep curls in the gym, lifting an unexpectedly heavy object, opening a stuck window, or as can happen when grabbing a rail to keep from falling.
Distal biceps ruptures are also more likely to occur in certain conditions. Patients who have been on oral steroids such as Prednisone, or antibiotics in the Fluoroquinolone class (Cipro, Levaquin) are at increased risk for tendon ruptures in general. Also, patients who have had a cortisone injection to the biceps, and those patients who have had previous trauma or tendonitis to the biceps tendon also have increased likelihood of rupturing the tendon.
Patients often experience sudden, sharp pain or "pop" in the elbow that can be heard of felt when the tendon ruptures. It can lead to swelling and bruising in the elbow and forearm. There may also be a bulge in the upper arm from where the muscle tendon has retracted and a resultant gap in the front of the elbow where the tendon was supposed to be. Patients usually notice that they are still able to bend the elbow as again the Brachialis muscle is actually the main elbow flexor, although the arm may feel a little weaker than normal. Like many tendon ruptures, after the initial injury, the elbow may not actually feel all that bad. Because of this patients often delay seeking medical help and sometimes assume surgical treatment is not necessary. It is crucial to seek treatment for distal biceps ruptures as soon as possible because a delay in treatment can lead to sub-optimal results.
This condition is usually diagnosed using clinical information gathered from the history and physical examination. Your physical examination will include evaluation of the affected extremity including range of motion and strength. Specific provocative tests involving the biceps and locating the biceps tendon are usually performed.
Dr. Steven Lee will often order an X-ray in addition to rule out possible fractures or other diagnoses. Other diagnostic studies such as MRI may be ordered to help confirm the diagnosis and guide further treatment.
Most patients with complete tears will benefit from surgical intervention in order to regain arm strength and function. Not doing so often leads to chronic pain and weakness that cannot be rectified satisfactorily later. However, in some cases, such as when the patient has serious medical conditions or complications that may put them at high risk for surgery or if they are elderly and infirm, non-surgical treatment may be considered. Patients do have to keep in mind that they will likely not regain full arm function and may suffer chronic pain and weakness.
Surgery is usually recommended for complete tears in order to reattach the tendon to regain arm strength, mobility and function. The procedure should be performed as soon as possible, preferably within 1-2 weeks, because the tendon will start to scar over, shorten, and weaken within this time frame. Delayed surgery although possible, can result in a more complicated and less successful surgery.
Repair of the distal biceps tendon involves making an incision over the area of the forearm where the tendon is supposed to attach. The tendon will be debrided (clean) to remove scar tissue and then secured back to the radius (forearm bone) with sutures, a securing button, and a screw. This surgery can usually be performed in less than 30 minutes in an ambulatory setting.
Elbow surgery is an area requiring special expertise in order to master because some elbow surgery is typically performed by hand surgeons, and others by sports surgeons, yet neither of them typically do a large quantity of elbow surgery. Dr. Steven Lee is uniquely fellowship trained in both hand/upper extremity surgery as well as sports medicine, and has is one of the most experienced orthopaedic surgeons for elbow surgery in NYC. He regularly instructs courses teaching other orthopaedic surgeons how to perform this operation.
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After surgery, patients will usually be placed into a splint, spanning from their upper arm down to the hand, in order to protect the surgical repair. Patients usually follow up in office to evaluate the surgical site within 7-10 days after the surgery. At this time, the surgical incision site will be checked and if ready, sutures will be removed.
During the recovery period, patients are advised to avoid activities such as pushing, pulling, carrying or excessive overhead motions with the affected arm. You should be able to use your fingers for light activities such as using a phone or computer.
At the first postoperative visit, patients are usually transitioned to a more comfortable brace, strapped from the upper arm down to the wrist. This brace is usually worn for about 4 weeks, and will start off with keeping your elbow bent but progressively allow more movement.
Physical therapy will be initiated gradually during the rehabilitation period, starting with range of motion exercises to regain mobility and modalities to decrease pain and swelling. Strengthening exercises are then gradually added to the therapy protocol. Therapy protocol will be provided to you and your physical therapist after the surgery.
Patients should expect to start regaining their strength by 12 weeks after the surgery and return to sports or full activity by 4-6 months depending on the sport or activity.
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Immediate Post-Operative Instructions
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*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.