Does A Bicep Tear Require Surgery?

A distal bicep tendon tear or tear of your bicep tendon at the elbow are a common cause of pain, swelling and a “Popeye” bicep deformity.  Many patients tell the same story. They were lifting something, usually with someone helping them.  The other person stumbles or let go and your end dropped—

POP!   You heard a horrible sound coming from your elbow. Over the next day or two swelling and bleeding will be seen around the elbow.  If you look closely you will notice a deformity of your biceps muscle. The bicep tendon is the most commonly torn tendon around your elbow. If you suspect that your tore your biceps tendon you should see an Orthopedic Surgeon sooner rather than later.  We prefer to fix these tendons — if you choose to have surgery — within the first 3 weeks after the injury.

The biceps not only assists you in bending your elbow, it helps you turn your forearm so you can turn a screwdriver, open a door, etc.  The biceps serves many important functions.

Injuries to the biceps are fairly common.  Most people who tear their biceps clearly recall the event.  You were helping someone carry something heavy, the other person let go and you felt your biceps tendon pop.  You went to lift up someting quickly and felt a pop.  These are very common stories.

The diagnosis of a distal biceps tendon tear near the elbow is usually not hard to make.  The question is:

Does A Bicep Tear Require Surgery?

The biceps tendon provides a lot of the strength necessary to turn your forearm.  If you are active, workout frequently, use hand tools, garden, etc you will likely rely on your biceps tendon frequently.

Surgery is not necessary for all bicep tendon tears.  But surgery for biceps tendon tears is recommended for many active adults.

Can you consider treating a biceps tendon tear without surgery?

Many of you might lead a very sedentary life.  You do not use your arms for anything more than normal activities of daily living.  If you are willing to live with a biceps muscle deformity, then you will usually do very well without surgery for your biceps tendon tear.  You shouldn’t notice any weakness, but might have an occassional spasm in the muscle.

If you, however, you live an active life, and certainly if you rely on your arms for work  then you should consider having surgery to repair your biceps tendon tear. As mentioned previously, distal biceps tears should be repaired within a few weeks after the injury.  Otherwise it might be very difficult to repair the tendon.

How is a Biceps Tendon Repaired?

When the biceps tears, the tendon snaps up into the arm.  We make a small incision across the front of the elbow, the torn biceps tendon is identified and brought back down to its normal attachment on a bone we call the radius.  Then we must attach it to the radius.  When we repair the bicep tendon tear we can use sutures, suture anchors or other devices which help secure the biceps back in place on the radius. After the biceps is repaired, the skin is closed and we place you into a splint.

After the surgery you are in a splint for a 7-10 days, then a sling.  You will likely start moving the arm soon to prevent stiffness, but you will not be allowed to lift anything for a number of months.  If you try to do too much you will re-tear the biceps tendon.

After we give the biceps tendon enough time to heal to the radius bone you start physical therapy.  Once you have completed your therapy, most patients are capable of returning to full activities — including sports, jobs with heavy lifting,  and weight lifting.

Risks of Biceps Tendon Surgery

There are risks to any surgery, and surgery for a biceps tendon tear is no different.  Overall the risks are very low.  The risks of a biceps tendon repair include infection, elbow stiffness, numbness in the forearm, and a potential injury to a nerve which can cause weakness in your wrist.