The biceps muscle is an important muscle in the upper arm. The distal tendon of the biceps muscle transmits all of the forces of the muscle to the forearm at its insertion (“radial or bicipital tuberosity”), thereby contributing to an athlete’s ability to forcefully flex the elbow as well as rotate their forearm in turning the palm upward (“supination”).
The distal biceps tendon can tear, preventing the transmission of forces from the muscle to the forearm bones. While it can happen from repetitive injury in athletes, it more commonly results from a single traumatic event in which the flexed elbow is resisted or even traumatically extended as in Sander’s case. The event is usually accompanied by a “popping sensation” and sense of sharp tearing around the elbow crease.
Once a distal biceps tendon is ruptured, it unfortunately will not heal on its own. Rather, the tendon will continue to retract away from the bone and slide up the arm as the muscle contracts without resistance. Over time, the tendon will be come stiff and scarred as well. This loss of biceps muscle function results in a loss of elbow flexion and forearm rotation strength (specifically turning the palm “upward”) in the arm. These injuries should be addressed acutely with surgical repair.
Usually the presentation of a distal biceps tendon is not subtle. There will be the acute onset of a “tearing sensation” at the elbow, often accompanied by a “pop” when the tendon ruptures off the bone. When compared to the normal arm, the tendon can no longer be palpated at the elbow flexion crease. Frequently, there is swelling and bruising around the elbow flexion crease as well.
Typically the diagnosis can be made by taking a history from the patient and performing a physical exam. Often, an MRI will be ordered to confirm a complete tear of the tendon as well as to assess any potential retraction of the tendon. Over the past few years, surgical techniques and implants have improved, which, when combined with people trying to stay more active, has led to an increasing number of distal bicep tendon repairs being performed. In the past, 2 incisions were typically needed to repair the tendon whereas now 1 is often used. Patients are protected in a brace for the first 6 weeks after surgery after which they progressively work on strengthening exercises before returning to sports. If one opts for surgical treatment of a distal biceps tear, the best results are achieved when done within 4 weeks of the initial injury.
The elbow is comprised of the upper arm bone (humerus) and the two forearm bones. The ulna is on the side of the pinky while the radius is on the side of the thumb. Articular cartilage covers the surfaces of the bones to act as a cushion that allows for smooth contact and movement. Tissue called synovial membrane covers the rest of the joint and lubricates the cartilage to allow for smooth movement of the elbow joint. Ligaments help keep the joint in place.
If a patient suffers from a painful and debilitating elbow condition that does not respond to more conservative treatment, elbow arthroscopy can be chosen as a surgical option. Drs. David Dines and Joshua Dines perform elbow arthroscopy to treat conditions such as:
- Tennis Elbow (lateral epicondylitis)
- Painful Scar Tissue
- Painful loose cartilage and bone fragments in the elbow (loose bodies)
- Bone spurs in throwers
Elbow arthroscopy is a minimally invasive surgery, in which the surgeon uses a tiny camera (arthroscope) to examine, diagnose, or repair tissues inside or surrounding the elbow. The arthroscope displays live video on a television that allows the surgeon to use small instruments in the joint. The surgeon uses one or several small incisions (usually 1cm or smaller) to insert the arthroscope and other small surgical instruments into the elbow.