The biceps tendon is a tendon in the elbow which helps with supination and elbow flexion. It attaches to the radial tuberosity in the proximal forearm. Distal biceps injuries typically occur in men (93%) in their 40's and usually occur in the dominant arm (86%). A tear usually occurs after an eccentric load (elbow pulled against resistance into extension). Partial tears involving less than 50% of the tendon can be considered for non-operative treatment with rest. Although NOT mandatory, complete tears are often fixed in higher demand patients to prevent loss of strength. A discussion with your surgeon on whether or not to surgically fix the biceps tendon is important. Without surgery, one can expect a loss of strength of up to 50-60% with prolonged supination (i.e. repetitive turning of the screw driver). Even with surgery, there can be a loss of 20% of the original strength. Risks of surgery include nerve damage, fracturing the proximal radius, extensive bone growth at the repair site causing motion restrictions, persistent pain and weakness, and other complications. Thus, surgery should be considered after thorough understanding of the risks and benefits of the procedure.
Repair of the biceps is done through a single incision on the front of the arm (see video below and to the left). The tendon is located and a hole is drilled into the proximal radius at the native attachment site of the distal biceps tendon (radial tuberosity). Strong suture called fiberwire is then sewn into the tendon and the suture is threaded through a button that is dunked into the drilled hole. The sutures are then tensioned to pull the tendon into the bone socket and an anchor is then inserted into the same socket to secure the tendon in place. A knot is then tied over the anchor and the skin is closed.
After surgery, effort is given to minimize tension on the repair. You will be in a posterior long-arm splint until your initial evaluation in clinic. At this point, you will transition to a hinged elbow brace and start therapy. Gaining full extension is a process that happens over weeks as elbow extension and pronation (turning the palm down) puts tension on the repair. Also, actively engaging the biceps with elbow flexion and supination tensions the repair and these movements are avoided initially. Motion is initiated with passive range of motion (i.e. motion without muscle activation).
