What is a distal biceps tear?

The biceps is one of the main muscles on the front of the arm that assists us in bending our elbow and rotating our forearm. The muscle attaches to the forearm bone through a tendon, which acts like a rope at the end of the muscle. A distal biceps tear is a rupture of the tendon from the forearm bone (radius). As the biceps is responsible for strength and turning the forearm, such as to open doors or twist a screw driver, ruptures result in weakness and pain with attempted loading.

What causes the condition?

Tears of the distal biceps tendon are almost always caused by a sudden injury to the elbow. This can happen when lifting objects that are too heavy, resulting in the elbow being forced straight when the bicep is under tension. This tears the biceps muscle and tendon from the bone.

What are the typical signs?

The common symptoms of a distal biceps tear are:

• Swelling and bruising around the elbow
• Difficulty bending the elbow
• Difficulty twisting the forearm
• Sudden elbow pain after injury
• A bulge in upper arm where biceps muscle has moved
• A snapping sound or a sensation of a ‘pop’ during an injury.

How is it diagnosed and treated?

Diagnosis

Your consultant will discuss your symptoms with you and perform a medical examination, during which they will look for tenderness and swelling, and your range of motion as well as identifying what positions cause pain to your elbow joint. This may be followed by an MRI scan to determine the severity of the tear.

Treatment

A distal biceps tear requires surgery. Conservative/non-surgical treatment is mainly recommended for older people with fewer requirements and that lead relatively sedentary lifestyles.

Non-surgical treatment: Involves rest, immobilisation by a sling, anti-inflammatory medicines and physiotherapy.

Surgery: The operation is conducted as a day-case (you will come into hospital on the morning of surgery and go home the same day). An incision is made at the front of the elbow to reattach the tendon to the forearm bone. Sutures are used to knit the tendon in an interlocking manner to attach the tendon on the bone. In chronic ruptures to bridge the gap between retracted tendon and bone, tendon graft is used. The skin is then stitched with absorbable sutures, a hinged brace is applied to the elbow. The operation takes around one to two hours.

Recovery

This depends on the type of treatment you’ve had, but can take from between 6 weeks and three months you’ve had surgery. Your consultant will be able to advise you on this.

When can I return to normal activities?

• Work - this depends on your individual employment and lifestyle, however if your job mainly involves sitting then an approximate guide is around two weeks post-surgery. If you have a more active/physical role, your consultant will be able to advise you on a suitable period of time, however it could take up to four months.
• Driving - You should not drive while in a sling, or while heavily bandaged. Once you have been reviewed back in clinic you will normally be allowed to drive once you are safe to do so. In practice, most patients find the elbow is too stiff and sore for approximately eight weeks after surgery.
• Exercise – Gentle exercise can resume as soon as your surgical incision has healed (two weeks), although the range of movement of your elbow is normally restricted until eight weeks post-surgery and heavy lifting is usually restricted for three months after surgery. Your surgeon may suggest weight restrictions that may be prolonged, depending on the type of surgery undertaken.