The biceps is a two-part muscle on the front of your upper arm that has a proximal (near the shoulder) and a distal (near the elbow) tendons that attach to the bones.
The biceps bends the elbow and also turns the palm of the hand up toward the ceiling like when receiving change in a shop or turning the handle of a door to open it.
A distal biceps rupture is when the portion of the biceps tendon that attaches to the forearm bone in the lower arm, called the Radius, tears away from the bone.
A common cause for a distal biceps rupture is usually trauma involving the elbow. For example, when a person attempts to pick up a heavy load, such as a box, and it is heavier than expected. The person flexes their biceps with a bent elbow, but the elbow is forcefully straightened against the lifting force causing the muscle to tear. A distal biceps rupture may also occur as a result of a fall or accident.
Biceps tendon tears can be either partial or complete.
Partial tears:These tears damage the soft tissue but do not completely sever the tendon away from the radius.
Complete tears: A complete tear means the tendon is completely detached from its attachment point at the bone so the muscle can no longer bend the elbow or turn the palm of the hand up.
In most cases, tears of the distal biceps tendon are complete. This means that the entire muscle is detached from the bone and it recoils up towards the shoulder.
Tears of the biceps tendon at the elbow are uncommon. They are most often caused by a sudden injury such as lifting a weight you are not prepared for (weight lifters) or falling from a height and instinctively reaching out to grab something to support your whole body weight (scaffolders)
Biceps tears at the elbow tends to result in greater arm weakness than injuries to the biceps tendon at the shoulder.
Once torn, the biceps tendon at the elbow will not grow back to the bone and heal by itself. Other arm muscles can make it possible to bend the elbow fairly well without the biceps tendon but they cannot fulfil all the functions of the elbow, especially the motion of rotating the forearm from palm down to palm up. This motion is called supination.
To return arm strength to near normal levels, surgery to repair the torn tendon followed by intensive Hand therapy is usually recommended.
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.
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.
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 surgeon.
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.
Post surgical Treatment:
After surgery, a hand therapist at Hand Kinetics can help reduce swelling and pain and increase movement and strength of the elbow, wrist and hand with a graded exercise programme.
The hand therapist may also fit the elbow with a protective splint and/or sling. It will take time to fully recover, so the therapist will assist in modifying activities until it is safe to return to forceful activities, such as heavy lifting.
If you have recently had surgery on your arm or hand please telephone before making an appointment so we can discuss this with you. We want to treat you safely and may need to discus your medical procedure with your surgeon.
Nonsurgical Treatment:
If you are older and less active, or if the injury occurred in your non-dominant arm some people opt for non-surgical treatment. 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 options focus on relieving pain and maintaining as much arm function as possible. Treatment recommendations may include:
- Rest. You may need to wear a sling for a while and rest the sore muscle.
- Nonsteroidal anti-inflammatory medications. Drugs like ibuprofen and naproxen reduce pain and swelling.
- Hand therapy. After the pain decreases, it is important to perform rehabilitation exercises to strengthen surrounding muscles in order to restore as much movement as possible.
Hand Kinetics Telephone: 0044 28 417 72301
www.handkinetics.com
contactus@handkinetics.com
