Operative Technique

A, An S-shaped incision is made on the volar surface of the elbow. The incision is begun 3 to 5 cm above the elbow joint and extended to the antecubital crease and then laterally to the radial head and distally into the forearm for a distance of 5 cm. The subcutaneous tissue and deep fascia are divided in line with the skin incision.

B, The biceps tendon is exposed and traced distally to its insertion into the bicipital tuberosity of the radius. The brachial vessels and median nerve are identified and traced.

C, A long Z-plasty of the biceps tendon is performed.

D, The distal segment of the biceps tendon is rerouted around the neck of the radius and passes it mediolaterally.

E, The divided biceps tendon segments are resutured side to side at a length that will maintain full pronation of the forearm and extension of the elbow.

The surgeon should avoid excessive tension on the tendon in young children and when the forearm is hyperflexible into pronation. The wounds are closed in routine fashion. An above-elbow cast is applied with the elbow in 30 degrees of flexion and the forearm in full pronation.