Distal Biceps Tendon Injuries

The biceps tendon is a tendon in the elbow which helps with supination and elbow flexion. It attaches to the radial tuberosity in the proximal forearm. Distal biceps injuries typically occur in men (93%) in their 40's and usually occur in the dominant arm (86%). A tear normally occurs after an eccentric load (elbow pulled against resistance into extension). Partial tears involving less than 50% of the tendon tin can be considered for not-operative treatment with rest. Although Not mandatory, complete tears are often fixed in higher demand patients to prevent loss of strength.  A word with your surgeon on whether or not to surgically set the biceps tendon is of import.  Without surgery, one can expect a loss of strength of upwards to 50-60% with prolonged supination (i.east. repetitive turning of the screw driver).  Even with surgery, in that location tin can be a loss of 20% of the original strength.  Risks of surgery include nerve impairment, fracturing the proximal radius, all-encompassing os growth at the repair site causing motion restrictions, persistent pain and weakness, and other complications.  Thus, surgery should be considered after thorough understanding of the risks and benefits of the process.

Distal biceps tendon tear

Repair of the biceps is washed through a unmarried incision on the front of the arm (encounter video below and to the left).  The tendon is located and a hole is drilled into the proximal radius at the native zipper site of the distal biceps tendon (radial tuberosity).  Potent suture called fiberwire is then sewn into the tendon and the suture is threaded through a push that is dunked into the drilled pigsty.  The sutures are and then tensioned to pull the tendon into the bone socket and an anchor is then inserted into the same socket to secure the tendon in place.  A knot is then tied over the ballast and the peel is closed.

After surgery, effort is given to minimize tension on the repair.  You will be in a posterior long-arm splint until your initial evaluation in clinic.  At this point, y'all will transition to a hinged elbow brace and start therapy.  Gaining full extension is a procedure that happens over weeks as elbow extension and pronation (turning the palm downwards) puts tension on the repair. Besides, actively engaging the biceps with elbow flexion and supination tensions the repair and these movements are avoided initially.  Motion is initiated with passive range of move (i.e. motion without muscle activation).

The following rehab protocol is to let sufficient protection of the repair while the tendon heals back down to bone while at the same time preventing elbow stiffness.  Your protocol may be modified by the surgical squad to meet your specific needs.  Below is a template for a distal biceps repair rehab protocol:

Phase 1:

Goals – minimize swelling, maintain finger range of motion, and let wound healing

Day Nix:

Proceed the arm elevated with ice on the inductive portion of the elbow
Finger motility – both active and passive is instituted to prevent stiffness
Proceed the splint clean and dry

Week ane-2:

At approximately 10 days postoperatively, a removable hinged elbow brace will exist placed. This brace will typically be locked in 45 degrees of flexion based upon the intra-operative tension of the biceps
Begin passive flexion besides as passive forearm rotation
Wean from the pain medications and transition to Tylenol for hurting

Phase Two:

Goals – gradually increase total passive range of motion while protecting the repair, in cases of more chronic biceps repair this protocol will be modified with less aggressive range of movement.

Week 3-6:

Calendar week iii: Increase passive elbow extension past 15 degrees to 30 degrees lack of extension. Brainstorm wrist extension, wrist flexion, radial deviation, and ulnar deviation as full finger motility and near full forearm rotation is obtained
Week iv: Increase passive elbow extension to 15 degrees lack of extension
Week 5 and 6: Goal of full extension by the cease of the week. Continue only passive elbow motion and forearm rotation.

Phase 3:

Goals – brainstorm agile range of move and initiate strengthening

Week 7-12:

Week 7: Begin active isometric strengthening of the shoulder muscles every bit well every bit the triceps
Week 8: Active range of motion of the elbow with no resistance can exist initiated
Week nine-12: Begin unmarried aeroplane resisted agile range of motility of elbow flexion, extension, supination and pronation. Start light with 2 pound weight and increase this past 3 pounds each calendar week. The goal of strengthening is depression weight with sets of 20-xxx to produce fatigue but not to overstress the repair.

For Athletes: At week xiii sport specific training can be re-initiated on a supervised basis. Contact athletes tin can return to sport at 5 months postoperatively.

For Laborers: Work specific exercises are initiated and a resumption to full action tin be accomplished by iv months with protection confronting overloading up to 5 months postoperatively.

Equally with all surgery delight call the clinic at 307-578-1955 if there are whatsoever concerns including abnormal redness or drainage around the wound,

fevers, chills, numbness, tingling or increasing pain.

This protocol can also be institute nether patient resources at openrangeortho.com

Definitions:

Passive Range of Motion – Motion across a joint without activating any muscles on either side of the articulation. To do this either some other person has to motion the joint for you or you take to use the nonoperative arm to get movement.

Active Range of Move – The joint is moved by the muscles crossing the joint. For instance for the elbow, the biceps flexes the joint and the triceps extends the joint.

Supination – This is rotation of the forearm so the palm of the hand is facing upward.

Pronation – This is rotation of the forearm and then the palm of the hand is facing downward.