Distal Biceps Tendon Tear

Distal Biceps Tendon Tears occur most commonly in men aged 40-60 years old, especially those engaged in manual labor, athletics or weight lifting.  However, Distal Biceps Tendon Tears can also happen in women and younger men.  Smoking leads to a 5x increase in the rate of Distal Biceps Tendon Tears because smoking decreases the blood supply to the Distal Biceps Tendon so that it can’t fully repair itself in between episodes of overuse.

The Distal Biceps Tendon usually tears with a painful pop during a heavy lift, or while moving a heavy object.  Tenderness, swelling and bruising often occur.  The biceps muscle, which is attached to the Distal Biceps Tendon, retracts up towards the shoulder.  Elbow flexion (bending) and supination (turning the palm up, such as when using a screwdriver, etc.) become painful and weak.  Without surgery, there is a permanent loss of 30% loss of elbow flexion strength, a permanent loss of 40-50% of supination strength and endurance, and a permanent loss of 15% of grip strength. This weakness can affect the ability to use tools, turning a door handle, lift heavy objects, etc.  In order to restore lost arm strength and endurance, most patients elect to have the Distal Biceps Tendon surgically repaired.  If a Distal Biceps Tendon Repair is performed within 3-4 weeks, normal strength and endurance of the biceps muscle is usually regained.  After 4 weeks, surgery can still be done, but scarring and muscle retraction may lead to some elbow stiffness and biceps weakness following repair.  After 6 weeks the Distal Biceps Tendon can resorb; the ‘use it or lose it’ principle in action.  If this happens, a cadaver (allograft) tendon may be required to reconstruct the resorbed Distal Biceps Tendon, which is a more complicated procedure that heals slower.  Therefore, it’s best not to delay and get evaluated by an Orthopedic Upper Extremity or Elbow Surgeon within a week or two after a possible Distal Biceps Tendon Tear so that it can be repaired in a timely fashion.

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 Distal Biceps Tendon is attached to the Endobutton with very strong suture.  A 4 mm drill hole is placed through the Distal Biceps Tendon’s attachment in the radius bone.  The Endobutton is passed through this hole to the other side of the bone, and then ‘flipped’ so it’s can’t pass back through the drill hole.  This entire Distal Biceps Tendon Repair can usually be performed through a single cosmetic incision as an outpatient procedure.

Distal Biceps Tendon Repair

This Distal Biceps Tendon Repair is strong enough to allow motion to be started after 1 week, decreasing the chance of stiffness.  So, following surgery, the elbow is splinted for only 1 week, during which time it must be kept clean and dry.  Bathing is safer than showering.  Wrap a towel around the dressing in case any water gets in, then place a plastic bag over the dressing and secure it tightly with rubber bands.  If a bathtub is not available, Walgreens makes the best cast covering.

The splint is removed at the first postoperative visit, roughly 1 week following surgery.  At this point, the incision can get wet in the shower, and elbow motion should be regained.  A hot shower is a great time to work on elbow motion with the other hand supporting the operated arm: fully straightening the elbow, fully bending it, and rotating the forearm from palm up to palm down.  After showering, blot the wound dry.  The stitches are absorbable: There are no stitches to remove.There is a piece of special tape over the wound.  The longer it stays, the nicer the wound will do.  It’ll fall off when it’s ready.  Don’t get the wound dirty or submerge the incision under water for 10 days after surgery.

A sling and 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 3 months, with return to full activities at 4 months.  The vast majority of patients do extremely well following Distal Biceps Tendon Repair surgery and are extremely satisfied.  Once the Distal Biceps Tendon Repair is fully healed, the arm essentially returns to normal.