Distal Biceps Tendon Tear
What Is A Distal Biceps Tendon Tear?
A distal bicep tendon tear is a condition that occurs when the tendon that attaches the bicep muscle to the elbow ruptures. This condition is relatively rare, with incidence rates reported to be 1.2 distal bicep tendon ruptures per 100,000 adult patients per year. This type of injury is found to occur more commonly within the dominant arm of men between 30 and 60 years of age. In fact, some have estimated that the dominant arm is the affected arm in nearly 86% of cases of distal bicep tendon tears.
Along the front of the upper arm lie the bicep muscles. The function of these muscles is to assist with rotating the forearm and bending the elbow. The ends of these muscles are attached to bones by way of tendons. In the shoulder, there are two tendons that attach the biceps to the shoulder. In the elbow, there is one tendon that attaches the bicep muscle to the radial tuberosity. This tendon is known as the distal biceps tendon.
Should this tendon become injured or torn, the individual is likely to report a loss of strength within the arm. They will also report being unable to rotate the arm from a palm facing downward position to a palm facing upward position with any force. Further, once the distal biceps tendon becomes torn or ruptured away from the bone, it will not grow back to the bone and surgical repair is required. There are two types of distal biceps tendon tears: partial and complete. In instances of a partial tear, the distal biceps tendon is not completely severed away from the bone. In contrast, with a complete tear, the distal biceps tendon is fully severed and no longer connects the biceps muscle to the bone.
In many instances, the patient will report an audible pop near the elbow at the time of the injury to the distal biceps tendon. At first, patients report very severe levels of pain within the elbow, which usually subsides after one to two weeks.
Other commonly reported symptoms of distal biceps tendon tear include:
• Apparent bruising around the elbow and forearm
• Swelling around the front of the elbow
• Weakness upon bending the elbow
• Weakness upon twisting the forearm
• A bulge near the armpit of the upper arm, caused by the recoiled biceps muscle
• A gap on the front of the elbow, caused by the ruptured tendon
Causes of Distal Biceps Tendon Tear
It is true that the precise pathogenesis of this condition is not well understood. Despite this, the most commonly reported cause of distal biceps tendon tears is by a blunt and sudden trauma or injury. Injury usually occurs when the arm is forced to straighten against resistance. Though less common, injury may occur when the elbow is forcibly bent against strong force.
There are several known risk factors for developing complications related to this condition. More specifically, smoking has been found to increase the risk for distal biceps tendon tears by nearly 7.5 times. It is believed that nicotine use can deprive the tendon of certain important nutrition. Men over the age of 30 are also at risk for developing a distal biceps tendon tear. Lastly, there have been some studies that have suggested that corticosteroid injections may be linked with a weakened tendon within the area.
Treatments for Distal Biceps Tendon Tear
Treatments that are non-surgical in nature are considered for patients who are at particular risk for harm, even during a modest surgery. These patients would include elderly patients or others with complicating medical difficulties. It is strongly recommended that the ruptured distal biceps tendon be repaired within two to three weeks in order to achieve optimal results. During the surgical distal biceps tendon repair, there are several ways in which the severed distal biceps tendon can be repaired. In some instances, the distal biceps tendon can be reattached by drilling into the bone and stitching the tendon to the bone. In other cases, the tendon is reattached by using small metal implants. Possible complications resulting from the surgical repair of a distal biceps tendon tear are generally mild and occur in only about 6-9% of patients.
Some common complications reported from this surgical procedure include:
• Weakness or numbing of the forearm
• Bone growth around the site where the tendon is reattached
• Second rupture, even after healing completely (particularly rare)
Following surgery, the patient will likely be instructed to keep the arm in a cast or splint for several weeks. The doctor may also recommend that the individual engage in physical therapy in order to facilitate healing, increase flexibility, and improve overall strength of the joint. In most cases of surgical repair of a torn distal biceps tendon, it can take between two to three months to completely heal.
During recovery, patients may want to take an over-the-counter (OTC) oral analgesic. The most recommended are non-steroidal anti-inflammatory drugs (NSAIDs), such as naproxen or ibuprofen. These medications can help reduce the symptoms of pain and discomfort, as well as reduce any swelling in the area.
Previous studies have shown very favorable outcomes following surgery. It has been noted that almost all of patients undergoing surgical repair of a distal biceps tendon tear are expected to be restored to a full range of motion following surgery.
Conclusion
Distal biceps tendon tear is a condition in which the distal biceps tendon (i.e., the tendon that connects the biceps muscle to the bone of the elbow) is ruptured or torn. There are two types of distal biceps tendon tears: partial and complete. If the tendon has completely severed, then surgery may be the patient’s only option. There are a number of risks associated with surgical distal biceps tendon repair; however, outcomes from this procedure are generally favorable. Patients are encouraged to speak with their doctor about the risks and benefits in order to determine if surgical repair is an appropriate treatment.
References
- Chillemi C, Marinelli M, DeCupis V (2007) Rupture of the distal biceps brachii tendon: Conservative treatment versus anatomic reinsertion—clinical and radiological evaluation after 2 years. Arch Orthop Trauma Surg 127:128.
- Freeman CR, McCormick KR, Mahoney D, Baratz M, Lubahn JD (2009) Nonoperative treatment of distal biceps tendon ruptures compared with a historical control group. J Bone Joint Surg Am. 91:2329-2334.
- Hetsroni I, Pilz-Burstein R, Nyska M, Back Z, Barchilon V, Mann G (2008) Avulsion of the distal biceps brachii tendon in middle-aged population: is surgical repair advisable? A comparative study of 22 patients treated with either nonoperative management or early anatomical repair. Injury 39:753-760.
- Kulshreshtha R, Singh R, Sinha J, Hall S (2007) Anatomy of the distal biceps brachii tendon and its clinical relevance. Clin Orthop Relat Res 456:117-120.
- Miyamoto RG, Elser F, Millett PJ (2010) Distal biceps tendon injuries. J Bone Joint Surg Am 92:218-2138.
- Safran MR, Graham SM (2002) Distal biceps tendon ruptures: incidence, demographics, and the effect of smoking. Clin Orthop Relat Res 404:275-83.
- Sotereanos DG, Pierce TD, Varitimidis SE (2000) A simplified method for repair of distal biceps tendon ruptures. J Shoulder Elbow Surg 9:227-233.
- Taylor CJ, Bansal R, Pimpalnerkar A (2006) Acute distal biceps tendon rupture—a new surgical technique using a de-tensioning suture to brachialis. Injury 37:838-842.
