Hand
Distal biceps tears occur most commonly in men aged 40-60 years old, especially those engaged in manual labor, athletics or weight lifting. The biceps usually tears with a painful pop when lifting or moving heavy objects. Tenderness, swelling and bruising often occurs. The torn biceps muscle retracts upwards, towards the shoulder. Elbow flexion (bending) and supination (turning your palm up, such as while using a screwdriver, etc) become painful and weak. Without surgery, there is a permanent loss of 30% loss of elbow flexion strength and a 40% loss of supination strength and endurance. Most patients wantto have the biceps tendon fixed to regain their strength. If surgery is performed within 3-4 weeks, normal strength and endurance of the muscle is usually regained. After 4 weeks, surgery can still be done, but scarring and muscle retraction may lead to some stiffness and weakness following repair.
The strongest way to repair the distal biceps tendon is with an ‘endobutton’, which is a 4×12 mm piece of metal with holes in it. The end of the biceps tendon is attached to the endobutton with very strong suture. A 4 mm drill hole is placed through the radius bone, where the biceps normally attaches to, and the endobutton is passed through to the other side, and then ‘flipped’ so it’s can’t pass back through the drill hole. The entire repair can usually be performed through a single, fairly small incision. It’s performed as an outpatient procedure, ie. you go home the same day.
The repair is strong enough to allow motion to be started after 1 week, decreasing the chance of stiffness. A splint should be worn when not performing range of motion exercises for a total of 4 weeks following the surgery. Light weights can be lifted at 2-3 months, with return to full activities at 3-4 months.
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