Open Distal Biceps Repair
The biceps muscle is located in front of your upper arm. It helps in bending your elbow, rotational movements of your forearm and in maintaining stability in the shoulder joint. The biceps muscle has two tendons, one of which attaches it to the bone in the shoulder and the other attaches at the elbow. The biceps tendon at the elbow is called the distal biceps tendon. A tear in this tendon will make it difficult for you to move your arm from the palm down to palm up position. Once the distal biceps tendon is torn, it cannot regrow back to the bone and heal by itself. Permanent weakness during rotatory movements of the forearm may occur if the tendon is not repaired surgically.
Biceps tendon tear can be complete or partial. In partial biceps tendon tear, the tendon does not tear completely. Complete tendon tears will cut the tendon into two parts. Tears of the distal biceps tendon are usually complete tears and the muscle gets separated from the bone.
Distal biceps tendon ruptures most often result from a sudden injury or lifting a heavy object. Additional risk factors, such as advancing age, smoking and use of corticosteroid medications, can also result in increased muscle and tendon weakness, which can lead to the tendon rupture.
Signs and symptoms
The most common symptom is a sudden, severe pain in the upper arm or at the elbow. You may feel a "pop" at the elbow when the tendon tears. Other symptoms include swelling, visible bruising, weakness in the elbow, trouble turning your arm from a palm up to a palm down position, and a gap in the front of the elbow, caused by the absence of the tendon. A bulge may also appear in your arm caused by the recoiled, shortened biceps muscle.
Distal biceps tendon rupture is usually diagnosed based on your symptoms, medical history, and physical examination. During the physical examination, your doctor will look for a gap in the tendon by palpating the front part of your elbow. Your doctor will diagnose a partial tear by asking you to bend your arm and tighten the biceps muscle. You may have pain if there is a partial tear. X-rays may be taken to rule out other conditions causing elbow pain. Using an MRI scan, your doctor can determine whether the tear is partial or complete.
There are several procedures to accomplish reattachment of the distal biceps tendon to the forearm bone. Some techniques require two incisions while in others one incision may be sufficient. In some cases, the tendon is reattached using stitches passed through holes drilled in the bone. Sometimes, a small metal implant may be used to attach the tendon.
During distal biceps tendon repair, your surgeon makes a small incision over the upper forearm, where the biceps muscle attaches to the radius bone. The torn biceps tendon is brought up through the incision. Then, the radius bone is prepared for tendon reattachment and to promote healing. Two suture anchors are inserted into the bone. These serve as anchorage for the tendon. The sutures from the suture anchors are passed through the tendon in a particular interlocking manner so as to ensure a strong tendon repair.
After the repair is complete, a hinged elbow brace is applied with your elbow bent at 90 degrees. The brace is removed after 6 weeks and it may take up to 6 months to 1 year to regain full strength.