Distal Biceps Repair

The biceps is a large muscle located at the front of your upper arm that runs from the shoulder to the elbow joint. It helps with bending of your elbow as well as in rotatory forearm movement. The elbow joint comprises the upper arm bone called the humerus, and two forearm bones called the radius and ulna. The biceps muscle has a tendon that crosses the elbow and attaches to the radius in the forearm. This tendon is called the distal biceps.

Distal biceps repair is the surgical fixation of a ruptured or torn distal biceps tendon to the forearm bone. There are several procedures to accomplish reattachment of the distal biceps tendon. Some techniques require two incisions, and others only one. In some cases, the tendon is reattached using stitches passed through holes drilled into the bone. Sometimes, a small metal implant is used to attach the tendon.

Indications

A distal biceps repair is usually indicated for rupture of the distal biceps tendon as a result of an injury while trying to lift something heavy, or from quickly straightening the elbow to reach for something. The common signs and symptoms of an injury to the distal biceps include:

• A “pop” or tear sensation at the front of the elbow
• Severe pain around the crease of the elbow
• Bruising and swelling around the front of the elbow
• Weakness in bending the elbow or twisting the forearm
• Warmth in the elbow and cramping in the arm
• Substantial pain and weakness of the entire upper extremity (shoulder to hand)

Preparation

In general, preoperative preparation for a distal biceps repair will involve the following:

• A review of your medical history and a physical examination
• Routine blood work and imaging
• Informing your doctor of current medications or supplements you are taking
• Informing your doctor of any allergies to medications, anesthesia, or latex
• Disclosing any recent illnesses or other medical conditions you have
• Adjusting the dose of your current medications or refraining from certain medications - such as blood thinners, which may affect clotting
• Refraining from solids or liquids at least 8 hours prior to surgery
• Arranging for someone to drive you home after the procedure
• Signing an informed consent form

Surgical procedure

Distal biceps repair surgery usually takes about 1 hour and is typically performed under general anesthesia. During the procedure, your surgeon makes an incision at the front of the elbow, over the upper forearm, where the biceps muscle attaches to the radius bone.  This allows your surgeon a clear view to repair the tendon. Sometimes your surgeon makes another incision on the back of the arm. The torn biceps tendon is brought up through this incision. Then the radius bone is prepared for tendon reattachment. Two suture anchors will be inserted into the bone. These serve as structural support for the tendon. The sutures from the suture anchors are passed through the tendon in a particular interlocking manner to ensure a strong tendon repair. More serious injuries may require placement of graft tissue obtained from your own body or from a donor, such as a hamstring tendon, to repair the distal biceps. Once the repair is completed, the incision is closed with stitches and a dressing is applied.

Postoperative care

After the repair, a hinged elbow brace will be applied with your elbow bent at 90 degrees. The brace will be removed after 6 weeks. You may begin gentle active elbow range-of-motion exercises to strengthen the biceps muscle and optimize elbow function. It can take 6 to 12 months to regain full strength. You may experience pain, swelling, and discomfort in the operated area. Medications are provided as needed to address these. Ice packs on the area can also help reduce swelling and pain and provide additional comfort. You are advised to refrain from strenuous or forceful activities such as lifting heavy weights until 3 months after surgery. Instructions on surgical site care and bathing will be provided to keep the wound clean and dry.

Risks and Complications

Distal biceps repair is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:

• Infection
• Bleeding
• Nerve injury
• Blood clots
• Re-rupture
• Revision surgery
• New bone formation (heterotopic ossification)
• Adverse reactions to anesthesia

Summary

Distal biceps tendon rupture most often results from a sudden injury to the arm or from lifting a heavy object. Permanent weakness during rotatory movements of the forearm may occur if the tendon is not repaired surgically. Distal biceps repair surgery helps individuals who are active, who perform physical work, or who want to return to sports with significant pain relief and restoration of functional mobility of the elbow joint.