Distal Biceps Repair

The elbow joint is made up of the upper arm bone called the humerus and two forearm bones called the radius and the ulna. The biceps muscle has a tendon that crosses the elbow and attaches to the radius in the forearm. This tendon is called the distal biceps. The main function of the biceps muscle is to bend the elbow and to rotate the forearm so the palm of the hand can face up. This tendon is strong so it does not get injured often. When it does get injured, it usually tears off of the bone deep in the front of the elbow. It most commonly tears when trying to lift something heavy or when quickly straightening the elbow to reach for something.

Often, patients who injure their distal biceps will feel a pop in the front of their elbow and have immediate pain. Patients frequently notice that the biceps muscle looks different after the injury. This “Popeye” deformity happens because the muscle shortens when it is not attached to the bone. Sometimes there will be swelling and bruising in the front of the elbow.

Treatment for a complete rupture of the distal biceps is usually surgical repair. Without surgery, patients can have less elbow bending strength and forearm rotation strength. This can be difficult for those who do manual labor. It is helpful to fix the tendon back to bone within 2 weeks. Surgery usually takes about 1 hour. The tendon is repaired through a small incision in the front of the elbow. Sometimes, a second incision in the back of the elbow may be needed. After surgery, a splint or brace is used to protect the repair for a short time while it heals. Patients usually get full motion back in 4-6 weeks, and full recovery can occur within 6 months.

In the elbow, the capitellum and the radius touch to absorb some the pressure transmitted from the wrist. In certain sports, like baseball and gymnastics, and in professions that require heavy lifting, more pressure than normal is transmitted to the outside of the elbow. This sometimes causes injury to the bone and cartilage of the capitellum called an osteochondral defect (osteo = bone, chondral = cartilage). Occasionally, osteochondral defects arise without injury. The reasons for this are not well understood. We often see this problem on an elbow x-ray; however, an MRI is most helpful for determining what type of treatment is needed.

Treatment for an osteochondral defect depends on what the cartilage surface looks like on an MRI. If the cartilage surface is intact, an extended period of rest may allow the bone under the cartilage to heal. If the cartilage surface is broken and fragmented, surgery may be needed to clean out the pieces, especially if the pieces are causing the elbow lock up with motion. Surgery to treat this problem is usually done arthroscopically through small incisions. On occasion, if the bone is badly damaged, a piece of bone and cartilage from another part of the body may need to be transplanted into the defect. This can also be done arthroscopically but may require a bigger incision if the defect is large. Recovery after surgery depends on the surgery.

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