Shoulder and Elbow

Biceps Tendon Tear at the Elbow

Anatomy

The biceps is the muscle in the front of the upper arm. It helps keep the shoulder stable and allows movement such as bending an elbow and rotating an arm. The biceps is attached to the bones of the shoulder and elbow by tendons. The tendon at the elbow (distal biceps tendon) attaches to a part of the radius bone called the radial tuberosity, a small bump on the bone near your elbow joint.

Description

Most often caused by sudden injury, a biceps tendon tear at the elbow tends to result in greater arm weakness than injuries to the biceps tendon at the shoulder. Without use of the biceps tendon, other arm muscles will make bending the elbow possible, however, these muscles cannot fulfill all elbow functions, such as rotating the forearm from palm down to palm up (supination). A biceps tendon tear at the elbow requires surgical repair to restore normal strength of the elbow. This is done by reattaching the tendon to the bone. There are two types of biceps tendon tears, partial and complete.

• Partial tear—The tendon is not completely severed.
• Complete tear—The tendon is torn off of the bone completely.

Symptoms

A distal biceps tendon tear can cause the muscle to ball up in the middle of the arm. When the tendon ruptures, there is often a "pop" at the elbow. Pain is severe at first, but may subside after a week or two. Bruising and swelling at the elbow are also common. Other symptoms include:

• Swelling—In the front of the elbow.
• Visible bruising—In the elbow and forearm.
• Weakness—When bending the elbow, and twisting or rotating the forearm (supination).
• Bulge in the upper arm—Created by the recoiled, shortened biceps muscle.
• Gap in the front of the elbow—Created by the absence of the tendon.

Nonsurgical Treatment

Although surgical repair is usually necessary, nonsurgical treatment may be considered for elderly or inactive patients, or for those who have medical problems that make modest surgery a high risk. Surgery to repair the tendon should generally take place no later than 3 weeks following the injury. After that, the tendon and biceps muscle begin to scar and shorten, which may make it impossible to restore arm function with later surgery. While there are options available for patients requesting late surgical treatment for this injury, they are more complicated and generally less successful. For these reasons, the decision to proceed with nonsurgical treatment should be weighed very carefully. Be sure to discuss all options and potential outcomes with your orthopaedic surgeon.

The decision to undergo shoulder replacement surgery should be a cooperative one made by you and your family along with your primary care doctor and orthopaedic surgeon. Your doctor will explain the benefits along with any potential risks and complications, both relating to the surgery and that could occur over time.

Surgery

To regain full strength and function of the arm, surgical repair should be performed within 2 to 3 weeks of the injury. There are several different procedures that may be used to reattach the tendon to the bone. Some orthopaedic surgeons use two incisions, while others prefer only one. The appropriate option for you will depend on a variety of factors.

With any surgery there are some risks, and these vary from person to person. Complications are typically minor, treatable and unlikely to affect your final outcome. Your orthopaedic surgeon will speak to you prior to surgery to explain any potential risks and complications that may be associated with your procedure.