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.
Dick Schoeninger
Dr. Luks: I under went surgery 8 weeks ago for two tears in my rotator. Supraspinatus and Subscapula. The doctor also discovered that I have had a complete tear of my bicep tendon and said that he could not re attach it due to the length of time since the injury. I am pretty sure the tear occurred in the shoulder. My question is…I am an avid tennis player and golfer. Will the bicep tendon prevent me from playing these sports? I am 70 years old. Thanks
Howard J. Luks, MD
nope.. the absent biceps will not be the reason you may not return to playing tennis.
Bruce
Dr Luks. I have a complete tear of my bicep tendon at the elbow, and have concerns of possible surgery complications, with possible loss of hand dexterity etc. Is this concern justified? The loss of dexterity would be a greater loss than the lack of arm strength if the non surgical approach were to be taken. Your thoughts? Many Thanks
Howard J. Luks, MD
Loss of motion following a distal biceps repair is very rare. If it is treated non-surgically, the risk of loss of motion is also very small. Just be sure the surgeon you are talking to performs many of these and is very comfortable with them.
Jeff
I have a complete tear of biceps tendon at shoulder and my biceps is deformed and feel soreness if lifting items or trying to bulge my muscle and my muscle does not get hard anymore. Should I think of surgery or leave it as is ? I am a 43 year old active man who also cut and split wood. This happened 3 days ago and I’ve been to hospital and it’s been conformed after X-rays and ultra sound. Thanks
Howard J. Luks, MD
Most proximal biceps can be managed without surgery. Spasm can become an issue, and the deformity will be permanent… but it is too early to tell about the pain. Some may choose to have it repaired because of the deformity and spasm… many others live long, active, happy lives with a non-surgically managed rupture
Brandon
Hi Doc. I had a distal bicep tendon rupture on July 8th playing baseball and swinging at a high pitch. I continued playing with it for about a month and finally went in to get it surgically repaired. After surgery, the dr. told me that he couldn’t fix it because the tendon shrunk and started scarring to the bicep. I am now two weeks out of surgery. I know playing baseball & softball was difficult after I tore the tendon and it hurt to swing. My question is, if I rest it over the winter (8 months) or so, will I still be able to play ball and golf pain free starting next spring? I’m only 28, the little loss of weakness isn’t huge to me but if it’s painful to keep doing the things I love I may want a second opinion on what I can do. Thanks for your help!
Howard J. Luks, MD
Sorry to hear that…
It is possible to use tendon grafts to be able to repair difficult ruptures… but that being said, many people return to a very active lifestyle with a non-surgically managed distal biceps rupture.
HJL
Howard J. Luks, MD
Btw… we would be more than happy to see you for a second opinion..
Feel free to contact my assistant at [email protected]
/hjl
Nick
Hi, i suffered a partial tendon tear at the elbow, the surgeon used ultrasound to identify it was still connected but also said the biceps tendon had stretched. my bicep has moved maybe 1.5″ up my arm.
He suggested conservative treatment initially but said an option to surgically Imbricate the tendon was available. Its my understanding this is folding the tendon and stitching it to shorten its length?
I cant find any information about this i was really hoping for surgery for the partial tear
” There is a heterogeneous and thickened appearance of the biceps tendon distally. Abnormal fibres can be traced to the radial tuberosity. There is some attenuation to the proximal aspect of the tendon. Fibers can be satisfactorily identified however. No evidence of gapping. There is some bunching of the distal muscle however, no clear muscular injury.
Opinion: the appearance would be consistent with a partial injury of the biceps tendon distally with subsequent scarring. There is elongation of the tendon. no evidence of muscle tear.
Howard J. Luks, MD
Hmm.. it sounds like you have a partial tear off the tuberosity (bone). An imbrication would not address this… nor is an imbrication performed often at all. Might I assume you have pain ??? Or are you considering surgery for some other reason? If a partial distal biceps tear due to tendinosis (degeneration) doesn’t respond to non-surgical mgmt, then reattaching it to the radial tuberosity is an option. That will also shorten it and restore the appearance.
Good Luck