Distal Biceps Injury
Distal Biceps Tendon Injury
The biceps muscle is made up of two separate muscles that attach at the shoulder and the elbow. At the shoulder, the biceps has two tendons: one attaches in the shoulder joint and one attaches to a bone located in the front of the shoulder called the coracoid. At the elbow, the biceps attaches to the radius bone (one of the forearm bones). The biceps is primarily involved in rotating the forearm, but also works in bending and extending the elbow.
Injuries to the biceps at the elbow are rare, but can occur when lifting a heavy load. These injuries can be a complete tear of the biceps tendon or a partial tear of the biceps tendon. Risk factors for injury include age, use of anabolic steroids, poor blood supply to the tendon, systemic illness (such as kidney disease), or use of steroid injections near the tendon.
Education
Symptoms & Diagnosis
Patients may feel or hear a pop when the biceps tendon injury occurs. Bruising may appear along the front of the elbow. Patients will have pain and may feel weakness of certain movements, such as forearm rotation or elbow bending. Patients may see a swelling of the upper arm where the biceps muscle retracts (or moves) after injury.
Distal biceps tendon injuries are diagnosed using physical examination and imaging studies to confirm the diagnosis. The physical examination is used to identify areas of pain, weakness, tendon defects, and an evaluation of the nerves of the arm. X-rays are used to look at the bones of the elbow. MRI (magnetic resonance imaging) may be used to take a closer look at the muscles of the elbow and identify any damaged tissue. If a patient has symptoms suggesting an injury to a nerve, an electromyography (EMG) test may be ordered to look at nerve function.
Treatment
Treatment of distal biceps tendon injuries can be done with non-surgical or surgical means. The goal of treatment is to reduce pain and regain function of the elbow. Non-surgical treatment is used in patients with partial tears of the biceps or elderly patients who are willing to accept a decrease in elbow strength and function. If the biceps is not repaired, patients will notice a 50% decrease in supination strength (rotating the arm up), 30% decrease in elbow bending strength, and 15% decrease in grip strength. Patients with a complete biceps tendon injury who choose to avoid surgery may also feel cramping of the biceps and may see a bump on the upper arm. The therapies listed below are used to reduce inflammation associated with injury and allow you to strengthen the elbow muscles and regain function. Non-surgical treatment options include:
Rest: Modifying your activities, particularly sports, is an important part of the treatment of a distal biceps tendon injury.
Non-steroidal anti-inflammatory medications (NSAIDs) can help decrease inflammation
Physical therapy: This is an important tool to help you strengthen and retrain the muscles of the elbow to work better together
Surgical treatment is recommended for most patients, in order to regain strength and function of the arm. Surgery should be performed as soon as possible, ideally within 2 weeks of the injury to prevent scar tissue.
Distal biceps tendon repair: This procedure is performed through an incision on the forearm and uses stitches and a small metal implant/anchor to reattach the biceps tendon to the radius bone. Patients will be immobilized after surgery and will slowly advance movement and strengthening of the elbow over a period of 3-4 months.
Disclaimer: The information presented on this page has been prepared by Dr. Kew and should not be taken as direct medical advice, merely education material to enhance a patient’s understanding of specific medical conditions. Each patient’s diagnosis is unique to the patient and requires a detailed examination and a discussion with Dr. Kew about potential treatment options. If you have specific questions about symptoms you are having and would like to discuss with Dr. Kew, please click below to contact our office to schedule a visit. We hope the information above allows our patients to more thoroughly understand their diagnosis and expands the lines of communication between Dr. Kew and her patients.