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Biceps Tendon Rupture at the Elbow
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The biceps muscle is located in the front of your upper arm. It is attached to the bones of the shoulder and elbow by tendons — strong cords of fibrous tissue that attach muscles to bones.
Tears of the biceps tendon at the elbow are uncommon. They are most often caused by a sudden injury and tend to result in greater arm weakness than injuries to the biceps tendon at the shoulder.
Once torn, the biceps tendon at the elbow will not grow back to the bone and heal. Other arm muscles make it possible to bend the elbow fairly well without the biceps tendon. However, they cannot fulfill all the functions of the elbow, especially the motion of rotating the forearm from palm down to palm up. This motion is called supination.
Causes of Biceps tendon rupture
Injury
The main cause of a distal biceps tendon tear is a sudden injury which may sometimes require urgent medical attention. Injuries to the biceps tendon at the elbow usually occur when the elbow is forced straight against resistance. For example, Lifting a heavy box without realizing how much it weighs. You strain your biceps muscles and tendons trying to keep your arms bent, but the weight is too much and forces your arms straight. As you struggle, the stress on your biceps increases and the tendon tears away from the bone.
Risk factors
Men, age 30 years or older, are most likely to tear the distal biceps tendon..
Additional risk factors for distal biceps tendon tear include:.
Smoking. Nicotine use can affect tendon strength and quality..
Corticosteroid medications..
Using corticosteroids has been linked to increased muscle and tendon weakness..
Symptoms of Biceps tendon rupture
A distal biceps tendon tear can cause the muscle to ball up near the shoulder. Bruising at the elbow is also common.
There is often a “pop” at the elbow when the tendon ruptures. Pain is severe at first, but may subside after a week or two. Other symptoms include:
- Swelling in the front of the elbow
- Visible bruising in the elbow and forearm
- Weakness in bending of the elbow
- Weakness in twisting the forearm (supination)
- A bulge in the upper part of the arm created by the recoiled, shortened biceps muscle
- A gap in the front of the elbow created by the absence of the tendon
Treatment of Biceps Tendon rupture
Nonsurgical Treatment
Nonsurgical treatment may be considered if you are older and less active, or if the injury occurred in your non dominant arm and you can tolerate not having full arm function.
It may also be an option for people who have medical problems that put them at higher risk for complications during surgery.
Nonsurgical treatment options focus on relieving pain and maintaining as much arm function as possible. Treatment recommendations may include:
- Rest. Avoid heavy lifting and overhead activities to relieve pain and limit swelling. Your doctor may recommend using a sling for a brief time.
- Nonsteroidal anti-inflammatory medications. Drugs like ibuprofen and naproxen reduce pain and swelling.
- Physical therapy. After the pain decreases, your doctor may recommend rehabilitation exercises to strengthen surrounding muscles in order to restore as much movement as possible.
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Surgical Treatment of Biceps tendon rupture
Surgery to repair the tendon should be performed during the first 2 to 3 weeks after injury. After this time, the tendon and biceps muscle begin to scar and shorten, and restoring arm function with surgery may not be possible.
It is necessary to perform surgery to reattach the tendon to the bone in order to regain full arm strength and function. It is therefore important to prepare well before the procedure.
Procedure. There are several different procedures to reattach the distal biceps tendon to the forearm bone. Some doctors prefer to use one incision at the front of the elbow, while others use small incisions at both the front and back of the elbow.
Surgical complications are generally rare and temporary.
- Numbness and/or weakness in the forearm can occur and usually goes away.
- New bone may develop around the site where the tendon is attached to the forearm bone. While this usually causes little limitation of movement, sometimes it can reduce the ability to twist the forearm. This may require additional surgery.
- Although uncommon, the tendon may re-rupture after full healing of the repair.