Biceps Tendon Repair Surgery / Distal Biceps Tendon Repair

The biceps muscles located in the front upper arm are attached to shoulder and elbow bones by tendons. Tears of these tendons at the elbow, called distal biceps tendons, are fairly uncommon (particularly in women). Other arm muscles can compensate for arm function if this tendon is injured, but without surgical repair the injured arm will have a 30-40% decrease in strength, especially when twisting the forearm upwards. Tears to tendon can be partial or complete depending on whether the soft tissue is only damaged or completely detached from bone.

The Biceps tendons are often damaged by sudden injury, especially when the elbow is forced straight against resistance, like trying to pick up something too heavy. Men over age 30 are most likely to tear the distal biceps tendon, with other risk factors being smoking and chronic corticosteroid use as they are linked to muscle and tendon weakness. Tendonosis refers to the weakening of the tendon over time.

When the distal bicep tendon ruptures there is often a popping or tearing sensation followed by severe initial pain that may go away after a week or two. Experiencing fatigue during repetitive motions may occur. There may also be swelling at the elbow, visible bruising at the elbow or forearm, and weakness when bending the elbow or twisting the forearm. A prominent, bulging “Popeye” muscle is often visually identified in the upper part of the arm.

For full restoration of arm strength and function, surgery is needed to reattach the tendon to the bone as it can’t reattach by itself left untreated. Common surgical procedures include attaching the tendon with stitches or anchors to holes drilled into the radius bone. Patients are typically able to resume heavy activities and manual labor after recovery. There are nonsurgical options for patients who can tolerate not having full arm function, including rest and altered activity, NSAIDs (nonsteroidal anti-inflammatories like Ibuprofen), and physical therapy.