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Treatment for Biceps Tendon Tear at the Elbow

Biceps Tendon Tear at the Elbow

TREATMENT

Surgery to reattach the tendon to the bone is necessary to regain full arm strength and function.

Nonsurgical treatment may be considered if you are older and less active, or if the injury occurred in your nondominant arm and you can tolerate not having full arm function. Nonsurgical treatment may also be an option for people who have medical problems that put them at higher risk for complications during surgery.

Nonsurgical Treatment

Nonsurgical treatment options focus on relieving pain and maintaining as much arm function as possible. Treatment recommendations may include:

  • Rest. Avoid heavy lifting and overhead activities to relieve pain and limit swelling. Your doctor may recommend using a sling for a brief time.
  • Nonsteroidal anti-inflammatory medications. Drugs like ibuprofen and naproxen reduce pain and swelling.
  • Physical therapy. After the pain decreases, your doctor may recommend rehabilitation exercises to strengthen surrounding muscles in order to restore as much movement as possible.

Surgical Treatment

Surgery to repair the tendon should be performed during the first 2 to 3 weeks after injury. After this time, the tendon and biceps muscle begin to scar and shorten, and restoring arm function with surgery may not be possible. While other options are available for patients requesting late surgical treatment for this injury, they are more complicated and generally less successful.

Procedure. There are several different procedures to reattach the distal biceps tendon to the forearm bone. Some doctors prefer to use one incision at the front of the elbow, while others use small incisions at both the front and back of the elbow.

 
single incision surgery for torn biceps tendon at elbow

One method for reattaching the tendon is through a single incision at the inside of the elbow.

Reproduced from Mirzavan R, Lemos SE, Brooks K: Surgical treatment of distal biceps tendon rupture. Orthopaedic Knowledge Online Journal 2007; accessed January 2016.

A common surgical option is to attach the tendon with stitches through holes drilled in the radius bone. Another method is to attach the tendon to the bone using small metal implants (called suture anchors).

There are pros and cons to each approach. Be sure to carefully discuss the options available with your doctor.

 
suture anchors used in surgery to repair torn distal biceps tendon

(Left) A suture and suture anchor. (Right) This x-ray taken from the side shows where the suture anchors are placed in the radius bone.

Complications. Surgical complications are generally rare and temporary.

  • Numbness and/or weakness in the forearm can occur and usually goes away.
  • New bone may develop around the site where the tendon is attached to the forearm bone. While this usually causes little limitation of movement, sometimes it can reduce the ability to twist the forearm. This may require additional surgery.
  • Although uncommon, the tendon may re-rupture after full healing of the repair.

Rehabilitation. Right after surgery, your arm may be immobilized in a cast or splint.

Your doctor will soon begin having you move your arm, often with the protection of a brace. He or she may prescribe physical therapy to help you regain range of motion and strength.

Resistance exercises, such as lightly contracting the biceps or using elastic bands, may be gradually added to your rehabilitation plan.

Be sure to follow your doctor’s treatment plan. Since the biceps tendon takes over 3 months to fully heal, it is important to protect the repair by restricting your activities.

Light work activities can begin soon after surgery. But heavy lifting and vigorous activity should be avoided for several months.

Although it is a slow process, your commitment to your rehabilitation plan is the most important factor in returning to all the activities you enjoy.

Surgical Outcome. Almost all patients have full range of motion and strength at the final follow-up doctor visit.

After time, return to heavy activities and jobs involving manual labor is a reasonable expectation.

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