Understanding Elbow Tears – Distal Biceps Tendon
In last week’s post, we concluded our discussion of the most common tears we see in the lower body, focusing on the hip labrum. Today, we will move on to the upper extremity and begin with the elbow. The elbow contains a few structures that we as physiotherapists see injured or torn. To begin, we will discuss the Distal Biceps Tendon. As we have done previously, I will summarize how these tears occur, their associated symptoms, and generally how the recovery/rehabilitation works with a distal biceps tendon tear.
What is a Distal Biceps Tendon Tear?
The biceps muscle, located in the upper arm, has two tendons: one near the shoulder (proximal tendon), and one near the elbow (the distal tendon). The biceps plays a key role in helping you bend your elbow and rotate your forearm. A distal biceps tendon tear occurs when this tendon is partially or completely torn from its insertion at the elbow. Although distal tears are less common than proximal ones, distal tears can lead to significant loss of function, weakness, and often require surgery or lengthy rehabilitation.
Causes and Risk Factors
A distal biceps tendon tear commonly results from a sudden injury and often occurs during activities that involve heavy lifting or forceful elbow straightening against resistance. Common mechanisms I see are lifting a heavy object unexpectedly or catching a heavy object. These injuries are most common in middle-aged males. Risk factors include a history of smoking, anabolic steroid use, and individuals with previous elbow injuries. There is often no warning of the impending tear.
Signs and Symptoms
Distal biceps tendon tears, when injured, present with clear symptoms that are usually immediate. These tears are commonly associated with a sudden sharp pain or “pop”, accompanied by swelling at the front of the elbow, and subsequent bruising. A visible bulge can be present in the upper arm while patients describe weakness in elbow flexion (bending) and especially supination (turning the palm upwards, such as with turning a doorknob or screwdriver)
Treatment Options
Distal biceps tears are commonly treated with surgery. However, for partial tears or in an individual with low functional demands, conservative management may be considered. Nevertheless, non-surgical treatment often results in some permanent loss of forearm supination and/or elbow flexion strength.
Surgery is the gold standard for active individuals with a complete tear. The tendon is reattached to the radius bone using one of several techniques. A prompt diagnosis for a distal biceps tendon rupture is important, as it’s been shown that surgical interventions within 2-3 weeks of injury have the best outcomes.
Recovery and Rehabilitation
Recovery after a distal biceps tendon tear varies for each individual. Post-surgical recovery follow a strict post-surgical protocol for returning to function, which may differ depending on the surgeon. In general, post-surgical patients will have an initial period of immobilization in a sling/brace. Subsequent physical therapy starts with a gradual progression of range of motion, followed by a progressive strengthening program when cleared to start loading the tendon. On average, full recovery is seen within 4-6 months, yet it may take longer depending on the nature of the surgical procedure, healing progress, and strength restoration
Conclusion
A distal biceps tear can be quite daunting, but many people make a full recovery with surgery and return to their normal activities. If you’re dealing with a biceps injury and you believe it may be a tear, do not ignore the signs and symptoms, as it can influence the outcome of your rehabilitation. If you are unsure, consult with one of the physiotherapists at Kamloops Physiotherapy & Sports Injury Centre, as they can guide you through a specific, individualized rehabilitation program that will improve your chances of a full recovery.
This blog post was written by physiotherapist Jacob Coelho. To book an appointment with Jacob or one of our other experienced therapists, call 250-314-0788 or book online HERE.