Bicep and Elbow Anatomy
The biceps muscle is located in the front of your upper arm and is attached to the shoulder and elbow by tendons — strong cords of fibrous tissue that attach muscles to bones. The tendon at the elbow is called the distal biceps tendon, which attaches to a part of the radius bone called the radial tuberosity, a small bump on the bone near your elbow joint. A tearing of the biceps tendon at the elbow is uncommon, and is typically the result of a sudden injury.
What is a Biceps Tendon Tear at the Elbow?
Biceps tendon tears can be partial or complete. Partial tears damage the soft tissue but do not completely sever the tendon. Complete tears happen when the tendon fully detaches from its attachment point at the bone. In most cases, biceps tendon tears at the elbow are complete, meaning that the entire muscle is detached from the bone and pulled up toward the shoulder.
The most common cause of distal biceps tendon tears is sudden injury. These tears are rarely associated with other medical conditions.
Injuries to the biceps tendon at the elbow usually occur when the elbow is forced straight against resistance, and is less commonly injured when the elbow is forcibly bent against a heavy load. For example, you may lift a heavy box without realizing how much it weighs. You strain your biceps muscles and tendons trying to keep your arms bent, but the weight is too much and forces your arms straight. As the stress on your biceps increases, the tendon tears away from the bone.
There are several risk factors that may contribute to a biceps tendon tear at the elbow, including:
- Being male, age 30 years or older
- Smoking. Nicotine use can affect tendon strength and quality.
- Corticosteroid medications. Using corticosteroids has been linked to increased muscle and tendon weakness.
Biceps Tear Symptoms
You may hear or feel a “pop” when the tendon tears. Pain is severe at first, but may subside after a week or two. Other symptoms include:
- Swelling in the front of the elbow
- Visible bruising in the elbow and forearm
- Weakness in bending of the elbow
- Weakness in twisting the forearm (supination)
- A bulge in the upper part of the arm created by the recoiled, shortened biceps muscle
- A gap in the front of the elbow created by the absence of the tendon
Your Raleigh Orthopaedic physician will discuss your symptoms and how the injury occurred, and then examine your elbow. During the physical examination, they will feel the front of your elbow, looking for a gap in the tendon. Your physician will test the supination strength of your forearm by asking you to rotate your forearm against resistance and compare it to the strength of your opposite, uninjured forearm. Imaging tests, such as an X-ray, ultrasound, or MRI may be ordered to create better images of soft tissues and rule out other problems that can cause elbow pain.
Treatment for Biceps Tear at the Elbow
To regain full strength and range of motion in the affected arm, surgery to reattach the tendon to the bone is necessary. If you are less active, older, or if the injury happens in your non-dominant arm, non-surgical treatment may be considered.
- Rest. Avoid heavy lifting and overhead activities to relieve pain and limit swelling.
- Anti-inflammatory medications. Drugs such as ibuprofen and naproxen can be taken to reduce pain and swelling.
- Physical therapy. After pain subsides, your physician may recommend rehabilitation exercises to strengthen surrounding muscles.
Surgery to repair a biceps tendon tear of the elbow should be performed during the first 2 to 3 weeks after injury. After this timeframe, the tendon and biceps begin to scar and shorten, and reattachment may not be possible. There are several procedures to reattach the distal biceps tendon to the forearm bone. Your Raleigh Orthopaedic surgeon may use one incision at the front of the elbow or multiple, small incisions at both the front and back of the elbow.
A common surgical technique is to attach the tendon using stitches through holes drilled into the radius bone. Another method is to attach the tendon to the bone with small metal implants, also known as suture anchors. There are pros and cons to each approach, so make sure you discuss the best option with your surgeon based on your specific injury.
Following surgery, your arm will be immobilized in a cast or splint. Your physician may prescribe physical therapy and resistance exercises to help you regain range of motion and strength. Light work activities can resume soon after surgery, but heavy lifting and vigorous activity should be avoided for several months. The biceps tendon will take over 3 months to fully heal, so you must stay committed to your recovery plan.
Expert Care for Elbow Injuries at Raleigh Orthopaedic
At Raleigh Orthopaedic, our team of elbow specialists provides a wide range of surgical and nonsurgical treatments for elbow conditions, including biceps tendon tears at the elbow. After thorough evaluation of your injury, we will determine the best care plan based, catered specifically to your needs. To schedule an appointment at one of our clinics in Wake County, please contact us today.