Distal biceps: The active individual’s injury
A distal biceps injury occurs most commonly with eccentric movement which is when you are activating your muscle while slowly lengthening it at the same time. An example is when you are attempting to lay a heavy object down without dropping it or slamming it down.
How many describe the injury:
Most times you notice or feel a pop in the elbow followed by bruising and/or visible deformity (but not always). Just like any tendon injury, they need to be fixed relatively soon, ideally 2 to 4 weeks at the latest but sometimes depending on the amount of retraction it can be fixed much later. The reason for this is that tendons are attached to bone on one end and muscle on the other. A tendon rupture typically tears from the bone, much like an anchor pulling away from dry wall. The muscle continues to contract like its made to do, slowly pulling the tendon further and further away from its original position. The longer the tendon is unattached or anchored down the tighter and shorter the muscle gets making it harder and sometimes impossible to stretch back to its original position.
The biceps is 80% to 90% of your forearm twisting strength. When it tears or injured, you lose that strength. It contributes to elbow flexion strength but there is another muscle that actually does more of that work.
Decades ago surgeon tried to fix them and had mixed reviews.
They did OK but had significant complications of extra bone formation, nerve injuries and stiffness. 30 to 40 years ago many people chose not to fix their biceps tendon due to these problems. With newer techniques and better understanding of the biceps tendon and elbow function, surgeon have been fixing these for the last 30+ years with relatively good predictable results.
Recovery after typically consists of early motion and limited to no lifting. Some surgeons use a hinged elbow brace and some don’t. The studies do not show a difference with or without a brace as long as the patient follow the activity restrictions to protect the repair. Usually a patient can start strengthening in 6 weeks after surgery and progress as tolerated. Most patient are back to sports and heavy labor by 3 to 5 months. There is a relatively low incidence of re-tearing this tendon later.
By: Stephanie Jones, AT