When people experience muscle pain as a result of an injury, they often think it’s “just a sprain” and delay seeking treatment to see if the injury will heal on its own. In the case of a torn biceps tendon, this approach could cost you. Elbow specialist Dr. Alexander Rowland tells me why.
So what is the biceps tendon?
Tendons attach muscle to bone in the human body. Your biceps muscle is the muscle in the front of your upper arm. It is attached to bone by two tendons at the shoulder, and one tendon at the elbow. The biceps muscle helps to stabilize your shoulder, bend your elbow, and rotate your forearm. In this example, we’ll be looking at the distal biceps tendon, which attaches the biceps muscle to the radius (a bone in the forearm).
How would someone tear their distal biceps tendon?
Distal biceps tendon ruptures occur when the tendon is overloaded and it tears off of the radius. This usually happens when someone tries to lift an object that is too heavy or lifts an object at an odd angle. When the biceps muscle is flexed against resistance and is suddenly pulled strait, the tendon fails at its insertion and pulls off of the bone.
Ouch! That sounds painful! Can it happen to anyone?
Yes, biceps tendon tears can happen to anyone, but these types of ruptures are most common in men between the ages of 40 and 60.
What symptoms would someone experience if they have ruptured their distal biceps tendon?
At the moment of injury, most people will feel a “pop” in the elbow, followed by pain and swelling. Other indications that you may have a torn biceps tendon include:
- Bruising on the front and inside of the elbow which develops within 24 hours of injury
- Weakness and increased pain when you flex your elbow or rotate your forearm
- The biceps muscle can look like it is positioned higher in the arm, toward the shoulder, as it has recoiled and shortened from the elbow
If you notice some combination of these symptoms after lifting (or attempting to lift) something heavy, you should contact your physician for evaluation and treatment within a week, even if your symptoms seem to be improving.
What’s wrong with waiting to see if it improves without treatment?
A rupture of the distal biceps tendon cannot repair itself. The tendon cannot reattach itself to the bone and so surgical intervention is needed.
Unfortunately, many people underestimate the severity of their injury and delay seeking treatment because:
- They can still move their arm, so they assume it’s just an elbow sprain/strain
- The pain is not terrible, so they think it’s not too serious
- The swelling/bruising generally subsides over 10-14 days, giving the appearance of healing
The downside to a delay in diagnosis and treatment is that surgical correction may no longer be possible, resulting in permanent dysfunction of the arm. Loss of bicep function through a distal rupture results in decreased strength of up to 40%. Although there are other muscles to help compensate for this loss, full strength is never regained without surgical repair.
When does surgery need to be done for a torn biceps tendon?
The best time to perform surgery (primary operative reinsertion) for a distal biceps tendon rupture is within 2-3 weeks of injury. After this time period, scarring and shortening of the tendon make successful treatment more difficult and sometimes impossible.
What does the surgery involve?
In surgery, your physician will reattach the biceps tendon to the forearm. The procedure is performed in an outpatient surgery center, and typically takes about an hour. Patients are discharged home in a splint to follow up in 7-10 days. Full unrestricted recovery takes 3-4 months, but use of the arm for daily activities is possible within 2-3 weeks.
Dr. Alexander S. Rowland is a board certified orthopedic surgeon, fellowship trained in the treatment of conditions of the hand, wrist, and elbow. He treats patients aged 6 years and older and has a special interest in distal biceps tendon tears, with over 150 cases performed. To schedule an appointment with Dr. Rowland, please call 210.281.9595.