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.
Jimmy
Howdy Doc, I ruptured distal bicep tendon on June 11th and finally had surgery on Sept 3rd. It was only retracted 3 cm, I’m currently in a ROM brace @ 75 degrees ROM. I’m a competitive powerlifter and my job requires lots of lifting and moving equipment. I’m saying February before I’m 100% does that seem about accurate. Thank you in advanced.
Howard J. Luks, MD
Every case is different Jimmy. I usually allow full motion within two weeks to decrease risk of stiffness… but do not start resistive exercises for nearly 3 months. Competitive weight lifting is 6 months down the road after surgery at a minimum. follow your surgeons instructions … they know what your tendon and repair was like and what’s needed at each stage of the recovery.
Jimmy
Dr. Luks, Thanks for the response. Trust me I following all instructions to the point! Ive got good range of motion, but Im in no hurry to rush back to the platform, I want to be 100% before I start attacking the weights again. So Feb, Mar, Apr I don’t care I can wait. Thanks again.
Anna
My partner had surgery just yesterday for complete distal Bicep rupture under general. The doctor couldn’t find the tendon to reattach.
Should We be asking for a second opinion of anything else we can do or. just accept it can’t be repaired?
Thanks
Howard J. Luks, MD
That’s really unusual … The tendon is always there
Nolan
Hi Dr,
I tore my bicep clean through the middle a week ago. According to sonar and doctor I saw, the tendons at elbow and shoulder are still attached to the bone but there was a total rupture of bicep. My bicep has moved up towards shoulder so I am assuming that it tore closer to the elbow side. I have the gap closer to elbow now. Advice from my doctor is to avoid surgery as this might not always be successful and can form scar tissue. I still have a lot of movement and can turn palm inward and outward (outward is a bit sore). I am 45 and still very active – your opinion on joining muscle to muscle?
Howard J. Luks, MD
Muscle tendon junction tears that are fresh… within a few weeks of injury can be repaired. The repair is more difficult, more unpredictable, and more time consuming. Not all tears need to be repaired… but that is a discussion to have with your surgeon
Gus Weinhart
I ruptured the proximal end long head bicep approximately 7 years ago….at the time no surgery was suggested…. Has technology or any procedures changes since to warrant surgery now…thanks
Howard J. Luks, MD
Gus… Many of us do not recommend surgery for proximal biceps tears unless the cosmetic issues or spasm bothers you.
SHERI LETZRING
My boyfriend has a distal bicep tendon rupture to his left bicep that happen the end of Aug. with getting into his dr, the referrals to get the MRI and then the appointment to see the surgeon to see what to do about getting surgery took almost 10weeks =o( He was scheduled for surgery 3 weeks ago but due to a cold they have postponed it and now the dr is saying it is to late to have the surgery?? should he get a second opinion??
Howard J. Luks, MD
He should … it is harder to reconstruct now.. but certainly not impossible.