Distal biceps ruptures commonly occur with resisted flexion (ie carrying a couch) in middle aged men. Patients often feel a pop and pain followed by bruising with pain located in their elbow and around their biceps. Patients with a tear to distal biceps tendon will still be able to flex their arm but will have loss of arm twisting strength (supination). While not all patients require fixation, those with occupations that require supination strength (manual laborers) fixation is often recommended. Physical exam is helpful to diagnose a torn distal biceps tendon. MRI can be used in cases of partial tear and localizing the retracted torn tendon.
Anatomy of the Distal Biceps
There are two muscles in your forearm, biceps and brachialis. Biceps main function is in rotation as it inserts into the radius. Brachialis main function is in elbow flexion as it inserts into the ulna.
Treatment for Distal Biceps Ruptures
Not all patients require fixation. Chronic pain is rare and if patients choose non-operative treatment they will be able to get back to most activities. If patients choose to have the tendon fixed it is important to have this addressed quickly (before 4 weeks) as the retracted biceps will scar down and become a potentially harder operation (reconstruction rather than repair).
Non-Operative
Partial tears may be to be treated with rest and if patients are unhappy they may choose to undergo an operation. Full tears treated without surgery can expect about a 40% loss of supination strength compared to the uninjured side but patients often have acceptable outcomes.
Operative
When thinking about surgery it’s important to discuss if the repair is anatomic vs nonanatomic. Restoring anatomy is key to regaining strength. Typically the tendon is held in place with either a metal button or a bone bridge while it heals. Patients are immobilized initially and started on range of motion early. Often it takes 3 months for the tendon to heal before heavy strengthening can start.
There are multiple ways to fix distal biceps below is an image from Arthrex using the endobutton technique compared to the power optimization technique.
Article comparing both techniques
Complications after Distal Biceps Repair
Patients often have forearm numbness that resolves over a few weeks to months. Nerve injury, fracture and formation of extra bone are some complications (2-5%) that can occur with surgery. It is important to discuss all treatment options with Dr. Chambers.