Distal biceps tendon tears are a relatively common injury, usually sustained by patients in the gym, or lifting heavy weights. Patients feel a tearing sensation, usually accompanied by some swelling and bruising.
Clinical examination and an ultrasound are usually enough to diagnose a bicep tendon injury, although sometimes an MRI is needed.
While this injury can be treated without surgery, patients wishing to return to full strength and have a normal looking biceps can have surgery. While most patients don’t require a cast or a sling after surgery, rehabilitation still takes 4-6 months.
Surgery needs to be performed in the first two weeks. This surgery is performed open, with the tendon repaired onto bone using a cortical button.
Postoperative rehabilitation
Distal biceps surgery is performed as day surgery at Women’s College Hospital. Someone must come and pick you up and take you home. It is advised to have someone around to help you for the first two days. All patients will be provided with a script for medications that should be filled at the hospital prior to going home. Medications will usually be Celebrex in the morning for 2 weeks, Aspirin at night for two weeks, and Tylenol regularly for the first week. A script for oxycodone will also be provided.
All patients will wear a sling initially after surgery. However, as soon as the patient feels comfortable, the sling can be removed and the arm used around the house. Physiotherapy will begin after surgery, with a script and protocol provided. Patients will not lift anything heavier than a coffee cup for the first 6 weeks.
If possible, patients should rent a Gameready machine, which provides ice and compression to the knee, significantly reducing postoperative pain. The information for the rental company will be provided to you. Patients are seen in clinic two weeks after surgery, for wound review.
Patients should take a week off work after the surgery. Patients are not allowed to play sport for 6 months after surgery.
Risks of surgery
Distal biceps surgery is a relatively safe operation. This is open surgery, with a 1/100 risk of deep infection, major stiffness, DVT/PE, major nerve or blood vessel damage. The risk of ulna fracture is 1/1000.
Patients can get local areas of numbness around the incision and down the forearm, which typically improves over a year or two. The risk of retear is approximately 5% – this is minimized by rehabilitating appropriately for 6 months and avoiding heavy lifting during this time.
There is a very small risk of injury to the radial nerve, which allows normal movement of the wrist and thumb. If this occurs, the function usually returns over time.
Dr. Tim Dwyer 