Distal Biceps Injuries
Understanding and Treating Tears of the Biceps Tendon at the Elbow
by Mr. David Shields
What is a Distal Biceps Injury?
The biceps brachii muscle is located in the front of your upper arm. It helps you bend and rotate your arm. The biceps muscle has tendons that attach it to the bones of the shoulder and elbow. The tendon at the elbow is called the distal biceps tendon. It attaches to a part of the radius bone, one of the bones in the forearm, called the radial tuberosity. There are actually 2 biceps tendons by your shoulder (proximal biceps or long/short head of biceps), but these are less frequently injured and not as problematic.
A distal biceps injury occurs when the distal biceps tendon is torn. Tears can be partial or complete. Partial tears damage the soft tissue but don’t completely sever the tendon. Complete tears detach the tendon completely from its attachment point at the bone. In most cases, tears of the distal biceps tendon are complete.
What Causes a Distal Biceps Injury?
The main cause of a distal biceps tendon tear is a sudden injury. These tears are rarely associated with other medical conditions, but may be related to use of some medications. Injuries to the biceps tendon at the elbow usually occur when the elbow is forced straight against resistance, such as when lifting a heavy box.
Risk Factors for Distal Biceps Injuries
Several factors can increase the risk of a distal biceps tendon tear, including:
- Age: Men age 30 years or older are most likely to tear the distal biceps tendon.
- Smoking: Tobacco use can affect tendon strength and quality.
- Corticosteroid and anabolic steroid medications: These drugs have been linked to muscle and tendon weakness.
Symptoms of a Distal Biceps Injury
Common symptoms of a distal biceps tendon tear include:
- Apop at the elbow when the tendon ruptures
- Severe pain that may subside after a week or two
- Swelling in the front of the elbow
- Visible bruising in the elbow and forearm
- Weakness in bending the elbow
- Weakness in twisting the forearm (supination)
- A bulge in the upper part of the arm created by the recoiled, shortened biceps muscle (popeye sign)
- A gap in the front of the elbow created by the absence of the tendon
Diagnosing a Distal Biceps Injury
To diagnose a distal biceps tendon tear, your doctor will take a medical history, perform a physical exam, and may order imaging tests.
During the physical exam, your doctor will:
- Feel the front of your elbow, looking for a gap in the tendon.
- Test the supination strength of your forearm by asking you to rotate your forearm against resistance.
- Compare the supination strength to the strength of your opposite, uninjured forearm.
Imaging tests that may be ordered include:
- X-rays: To rule out other problems that can cause elbow pain.
- Ultrasound: To show the free end of the biceps tendon that has recoiled up in the arm.
- Magnetic resonance imaging (MRI): To show both partial and complete tears of the biceps tendon.
Treatment Options for Distal Biceps Injuries
Treatment for distal biceps tendon tear depends on the severity of the injury and patient’s individual needs.
Non-Surgical Treatment
Non-surgical treatment may be recommended for:
- Older Older, less active patients
- InjuriesInjuries to the non-dominant arm
- Rest:Patients who can tolerate not having full arm function
Non-surgical treatment focuses on relieving pain and maintaining as much arm function as possible.
It may include:
- Rest: Avoid activities that cause pain.
- Ice: Apply ice to the affected area to reduce swelling.
- Compression: Use a bandage to help reduce swelling.
- Elevation: Keep the affected arm elevated to help reduce swelling.
- Pain relief medication: Over-the-counter pain relievers, such as paracetamol or ibuprofen.
- Physiotherapy: Exercises to help strengthen the muscles around the elbow and improve range of motion.
Surgical Treatment
Surgery is usually recommended for:
- Younger, more active patients
- Patients who require full arm function
The goal of surgery is to reattach the torn tendon to the bone. There are several different surgical techniques that can be used.
Rehabilitation after surgery is crucial to regain full arm strength and function It may include wearing a sling, doing exercises, and gradually increasing activity levels as directed by your doctor.
Surgical Treatment
Surgery might be considered if non-operative treatments aren’t successful:
- Ligament Reconstruction: The torn ligament is replaced with a tissue graft (either from your own body or a donor), creating a new ligament.
- Fracture Fixation: If you have a broken bone, the fragments are put back into place and held together with screws and sometimes a metal plate.
- Ligament Repair: Some ligament injuries can be repaired with specific stitches. Repairs can also be combined with extra suturing for added support.
- A Complex dislocations: These may require surgery to realign the elbow, which can also involve repairing any damage to nerves, ligaments, or blood vessels.
FAQs About Distal Biceps Injuries
What is a distal biceps tendon?
The distal biceps tendon connects the biceps muscle to the radius bone in your forearm, enabling you to bend your elbow and rotate your forearm.
How long does it take for a distal biceps tendon to heal?
The healing time for a distal biceps tendon injury depends on the severity and the chosen treatment. With non-surgical treatment, it may take several weeks to months for the pain to subside and function to improve. If surgery is required, it can take several months for the tendon to fully heal and regain strength.
When can I return to work after a distal biceps injury?
Return to work after a distal biceps injury depends on the nature of your job and the treatment received. If your work involves heavy lifting or repetitive arm movements, it may take longer to return. It’s essential to follow your doctor’s recommendations and gradually increase your activity level to avoid re-injury.
What are the long-term effects of a distal biceps tendon tear?
Even with proper treatment, a distal biceps tendon tear can result in some long-term effects, such as:
- Weakness: You may experience some residual weakness in your elbow, particularly with supination (twisting your forearm).
- Loss of motion: You might have a slight decrease in your elbow’s range of motion, particularly with supination.
- Arthritis: In some cases, a distal biceps tendon tear can increase your risk of developing arthritis in the elbow joint later in life.
What should I do if I think I have a distal biceps injury?
If you suspect you have a distal biceps injury, it’s crucial to see a doctor or an upper limb specialist promptly. Early diagnosis and treatment can improve your chances of a full recovery.
The Upper Limb Clinic
At The Upper Limb Clinic, we specialise in the diagnosis and treatment of a wide range of upper limb conditions, including distal biceps injuries. Our team provides personalised care tailored to your individual needs. If you’re experiencing elbow pain or suspect you may have a distal biceps injury, please don’t hesitate to contact us for a consultation.
We offer:
- Expert diagnosis and treatment
- State-of-the-art facilities
- A patient-centred approach
