Copy of Distal Biceps Rupture

Distal Biceps Repair

The Biceps Tendon connects the Biceps muscle to the Radius (one of the forearm bones)
Flexes(bends) the elbow and supinates the forearm (turn the hand from the ‘palm down’ to the ’palm up) position.
A tear of the tendon commonly happens when the there is unexpected heavy load on the arm. (eg. Lifting a very heavy object, or when some else lets go while carrying a heavy object together).
The injury usually occurs in males over 40, of muscular build.

•Sudden pain occurs in the cubital fossa (crook of the elbow). The pain can radiate into the forearm.
•Often the Bulk of the biceps muscle retracts proximally (up the arm).
•A bruise often occurs on the inside of the forearm after a few days.
•The pain from the tendon tear often settles after a week or two.

•If left untreated the pain from the ruptured tendon usually subsides almost completely after 4-6 weeks.
•Some cramping of the biceps muscle can occur because it has shortened, it usually subsides over 6 months
•Elbow flexion (bending) strength usually recovers almost completely (about 90%), but the ability to supinate (turn the forearm from the ‘palm down’ to the ‘palm up’ position) is weakened by 30-40%.
To recover full strength and normal contour to the distal biceps can be surgically reinserted to the radius.

•This kind of surgery usually requires a General anaesthetic (being ’completely knocked out’)
•Local anaesthetic is injected around the repair site (that numbs the area and can partially paralyse the arm for about 12 hours) to help with pain relief.
•The surgery is usually done as a day case, but an overnight stay can be arranged if required for practical reasons.
•Antibiotics is usually administered at the time of surgery, but does not have to be continued after surgery.

•Surgery usually takes about an hour.
•But the whole process of going to theatre and waking up from surgery takes longer.
•Usually, the surgery is don with a 2-3cm incision in the proximal(upper) forearm.
•Sometimes a a second incision is needed further up the arm to retrieve and suture the retracted tendon
•The tendon is retrieved and sutured with strong sutures.
•The tendon’s path is carefully cleared past the large blood vessels and nerves in the cubital fossa to the tendon’s insertion site on the radius.
•Two sturdy ‘all suture’ anchors are then used to anchor the tendon to bone.

In Hospital

A large bandage is applied to the elbow.
It is important that the arm remains elevated ‘higher than your heart’ as much as possible to help limit swelling.
Do not hesitate to ask for pain killers. It is much better to ‘stay on top of pain’, than ‘to catch’ up when it is severe.
If the bandage feels too tight, do not hesitate to remove it.
It is common to have some numbness in the forearm and even lose the ability to extend one’s wrist for up to 24 hours after the surgery due to local anaesthetic injected during surgery. Please let my rooms know if it lasts for longer.
It is usual to leave hospital 2-3 hrs after surgery

At Home

Continue to elevate your arm for about 3 days until swelling in your arm subside.
Keep the wound dry covered and clean.
Remove the bulky bandage 2 days after surgery
It is OK to remove your sling gently flex and extend your elbow. The sling it should stay on most of the time (including when asleep) for 6 weeks.
Blood thinning medication (if you are on any) can be started 2 days after surgery
An appointment usually arranged with my practice nurse at about 1-2 weeks after surgery.
Please do not drive before speaking to your physiotherapist or a doctor.
We normally prescribe an anti inflammatory to be taken for a month after surgery, to help prevent bone from forming inth surgical site (heterotopic ossification).

The wound usually heals over 1-2 weeks and any sutures are then removed
Self care (washing, dressing, eating) with the operated hand – usually around 5 days
Driving: when you are able to control a steering wheel with your operated hand and you are not taking strong pain relief anymore (usually 5-10 days post surgery)
A sling is usually worn full time for about 6 weeks
When you feel comfortable enough you can start gentle range of motion exercises. These will be demonstrated at your first post operative review
Please avoid lifting anything heavier than a small cup of tea (250g) for 6 weeks post surgery.
From 6-12 weeks sling wear can be weaned. But it may still be sensible to wear it when out and about.
Gradually increase lifting to 5kg in this time.
Most moderately activities can usually be achieved by 3-4 months, but it will take 6 -9months to become completely comfortable and to return to maximal effort.
Maximal effort (e.g. In the gym) should be avoided for 6 months

Infection occurs rarely(1% of the time), but can be severe. It may need further operations, weeks in hospital. It can lead to a poor outcome.
It is common to have a bit of numbness next to the scar, which normally resolves over time. Very rarely, more significant nerve damage can occur, resulting in paralysis or numbness in the arm. If it occurs, it usually improves significantly over 3-4 months.
Excessive bone can form in the surgical site (heterotopic ossification). It usually does not cause significant loss of function, but it can be uncomfortable and a lump will be present.
Rarely, the reconstruction can fail, may not heal completely, causing ongoing pain, weakness and recurrence of the deformity.
A general anaesthetic can have complications, such as nausea, heart and lung problems. Please discuss it with your anaesthetist before the operation.

A full recovery is usually expected with normal power and shape to the biceps.
Mild discomfort and stiffness occasionally persist despite successful surgery.
Strength usually recovers, but it can take up to a years to reach maximal improvement.