Your biceps muscle is located at the front of your upper arm. When the muscle contracts it pulls the forearm up and rotates it outwards. Tendons attach the biceps muscle to the shoulder blade (scapula) and the radius bone of the forearm. There are two proximal biceps tendons, of which the long head of biceps tendon is the most relevant as it passes throught the shoulder joint to attach on to the shoulder socket.
Your biceps tendons can cause symptoms in a number of different ways:
- Distal biceps tears at the elbow, partial or complete
- Distal biceps tendonitis
- Proximal biceps tendonitis or subluxation at the shoulder
- Promixal biceps tendon tear
In this blog we will focus on injuries affecting the distal biceps tendon.
Causes of distal biceps injury
Overusing any tendon can cause it to become painful and sore and may result in micro tears that result in tendonitis. This may be due to making repetitive motions – for example, in weight lifting, tennis or golf. Alternatively, you may tear your tendon away from the bone if it is subjected to a sudden overload – for example, by lifting something that it too heavy. While you struggle to keep your arms bent to support the load, the weight of it may force your arms straight, causing the tendon to tear at the elbow.
You may experience a partial tear, which is where the tendon is torn but not completely detached from the bone, or a complete tear. The latter tend to occur more frequently than partial tears. In a complete tear, the muscles may be pulled towards the shoulder, causing a characteristic lump near the shoulder which is often accompanied by bruising at the elbow.
Who is at risk of distal biceps tears?
Distal biceps tears occur most often in men. You may be at risk if you do a lot of heavy weight training, especially if you take anabolic steroid (e.g. testosterone supplements). Men who are aged around 50 are also are risk due to repetitive wear and tear over time. Patients who smoke or take corticosteroid medication (e.g. prednisolone) are also at risk.
Symptoms of distal biceps tear
Because the other arm muscles compensate for an injured biceps tendon, you will still be able to bend and use your arm even if the tendon is torn. However, without surgical repair you will normally experience a 30-40% decrease in strength, particularly when twisting the forearm palm-up.
If you tear your distal biceps tendon you may hear a popping sound at your elbow and experience severe pain. With complete rupture the pain will usually subside over the nexrt few days, however the pain from partial tears is persistent for weeks and months if untreated. You may also notice swelling and bruising around the elbow and forearm and a feeling of weakness when you bend your elbow. You may notice a bulge in the upper part of your arm and a gap in front of the elbow where the tendon would normally be.
Diagnosis and treatment of distal biceps injury
If you suspect you may have injured your distal bicep, it’s important to get a proper diagnosis and treatment as a complete tear will not heal on its own. Your doctor will examine you and ask you to move your forearm to check for loss of strength. You may need imaging tests such as ultrasound or MRI to reveal the extent of the injury. Sometimes an X-ray is used to rule out other problems that can cause elbow pain.
The normal treatment for a distal biceps tear is surgery to reattach the tendon to the bone so you can regain strength and function in your arm. In some cases – normally if you are older and less active or have certain medical conditions that increase your risk of surgical complications – you may be offered non-surgical treatment. This normally involves resting the arm and having physiotherapy.
Surgery to repair a torn distal biceps tendon is best performed within three weeks of the injury as the soft tissues begin to shorten and scar after this time which may make it impossible to restore full function. There are different approaches to surgery. Usually one incision is made on the front of the forearm near the elbow. However if the tendon has retracted a long way up the arm a second incision higher up is sometimes needed to retrieve it.
There are different methods of fixing the tendon to the bone. There is no real difference in the average outcome between each method, provided that there is no complication. Methods that involve drilling through both sides of the radius bone to place a small metal button on the backside of the bone provide a very strong repair but carry a higher risk of injury to the nerve that controls finger straightening, which is very debilitating and almost never recovers. For that reason, we prefer to use small anchors to repair the bone onto the bone in a more natural position with much lower risk of nerve damage. You will need to wear a sling for a couple of weeks while your arm heals and physiotherapy can help you to regain full range of movement and strength. Most people can return to heavy lifting after three months.
If you have elbow pain or suspect you may have a torn distal biceps tendon contact us to arrange a diagnosis.
Orthopaedic Consultant & Surgeon | London
Thames Shoulder & Elbow are able to provide advice and support to anyone experiencing symptoms affecting the upper limbs (shoulder, upper arm, elbow, forearm and wrist).
Telephone: 020 376 15987
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