Biceps Tendon Tears at Elbow

The biceps tendon is responsible for bending the elbow and twisting the forearm. Patients without a biceps tendon at the elbow usually have weakness when doing activities such as turning a screwdriver.

Is this the same as a biceps tear at the shoulder?

The biceps tendon has two attachments at the shoulder and only one at the elbow. If the biceps tears from the shoulder, there is still one more attachment point for the biceps, so it can function normally. If the biceps tears from the elbow, there is no other attachment that can compensate for the tear.

What is the cause of a biceps tear?

Most biceps tears happen in individuals who do repetitive heavy lifting. Age makes a difference as well because the tears occur most often in individuals between the ages of 40 and 60. The biceps tendon will wear out over time and loosen from its attachment on the bone in the elbow. Typically, you will experience a tear after you try to lift a heavy object.

How do you diagnose a biceps tear?

The biceps muscle will retract and look more round on the arm compared to the opposite arm. A day or two after the injury, black and blue marks will be seen over the elbow and there will be pain on the front of the elbow. A careful exam by a doctor can be done to make the diagnosis. An MRI is usually not needed to make the diagnosis of a complete tear, but an MRI may be needed to diagnose a partial tear.

How do you treat a biceps tear?

The biceps tendon will not reattach to the bone on its own because the muscle will always pull the tendon far away from its attachment site. Surgery is needed to repair the tendon and it should be done within 6 weeks of the tear before the tendon scars far away from the elbow.

During surgery, an incision is made a few inches down from the elbow crease and the tendon so that it can be sewn up with high strength sutures. A hole is also made in one of the forearm bones and the tendon is pulled into the hole with the sutures. The sutures are held in place with a small metal button on the other side of the bone. The metal button will not need to be removed and there's not need to worry for frequent flyers as it won't set off metal detectors.

After surgery, the elbow must be protected with a splint for 6 weeks. Patients can gradually bend the elbow more and more over the first 6 weeks depending on the quality of the tendon and the amount of retraction of the tendon during surgery.

After 6 weeks, patients can use the arm for lifting a pound or two. The tendon takes at least 12 weeks to heal, so strengthening cannot start until three months after surgery. Patients with light duty jobs can return to work in a week or two. Patients with heavy duty lifting jobs may need up to six months of rehabilitation before returning to work full duty.

Recovery Timeline

• First 2 weeks: Keep the arm in the sling except for showers and stretching the elbow. Bend the elbow with the help of the other hand twice a day.
• 2 weeks: Start therapy with your therapist so you can learn the stretching exercises that you will need to do at home 3 times a day. You cannot do any lifting with the arm or hand. Keep the arm in the sling all other times.
• 4 weeks: You can now stop using the sling and you can lift a coffee cup with the arm. Continue with your physical therapy visits and start stretching the arm behind your back.
• 10 weeks: Now you can start a strengthening program for the shoulder and the biceps. You may gradually increase the weight you lift as pain allows.
• 4 months: Most patients are able to normal daily activity around the house and at the office with minimal pain. You can start working towards getting back to your usual sport like swimming, tennis or golf.

The risks of surgery include failure of the tendon to heal, injury to a small nerve that is directly underneath the biceps muscle and forearm rotation stiffness. These risks must be considered before you decide to go forward with surgical repair of the tendon.