Biceps Tendon Disruption, Distal

Biceps Tendon Disruption, Distal



Description


Distal biceps tendon disruption is a complete rupture of the elbow attachment of the biceps muscle. The biceps muscle attaches to bone via tendons: two at the shoulder and one in the elbow. This uncommon injury happens when the tendon pulls off the bone just below the elbow. Although partial tearing of the tendon from the bone may occur, the tendon usually pulls completely off the bone. Rarely, the muscle may tear at the muscle–tendon junction.


The biceps muscle is important for bending the elbow and rotating the wrist. Rupture of this tendon may result in about a 30% loss of elbow bending strength and about a 40% loss of strength in turning the palm up with wrist rotation.



Common signs and symptoms



• Pain, tenderness, swelling, warmth, or redness at the elbow, usually in the front of the elbow

• Pain that is worse with elbow function against resistance and when straightening the elbow

• A bulge seen and felt in the arm

• Bruising in the elbow or forearm after 24 hours

• Limited motion of the elbow

• Weakness with attempted elbow bending, lifting, and carrying or rotation of the wrist, such as when using a screwdriver

• Crepitation (a crackling sound) when the tendon or elbow is moved or touched


Causes



• Sudden, forced straightening the elbow while the biceps is contracted and the elbow is bent

• A direct blow or injury to the elbow (rarely)


Factors that increase risk



• Sports that involve contact, as well as throwing sports, gymnastics, weight lifting, and bodybuilding

• Heavy labor

• Poor physical conditioning (strength, flexibility)

• Inadequate warm-up before practice or play


Preventive measures



• Appropriately warm up and stretch before practice or competition.

• Allow time for adequate rest and recovery between practices and competition.

• Maintain appropriate conditioning that includes elbow flexibility, muscle strength and endurance, and cardiovascular fitness.

• Use proper technique.


Expected outcome


Surgery is usually required to reinsert the tendon into the bone to optimize recovery of strength and function. Complete healing usually requires 4 to 8 months before returning to sports or heavy lifting.



Possible complications



• Weakness of elbow bending and forearm rotation, especially if treated nonsurgically

• Prolonged disability

• Re-rupture of the tendon after surgery

• Risks of surgery, including infection, bleeding, injury to nerves, elbow or wrist stiffness or loss of motion, and weakness with elbow bending and wrist rotation


General treatment considerations


Initial treatment consists of medication and ice to relieve the pain, and a sling may be recommended for comfort. Definitive treatment requires surgery to reattach the tendon back to the bone, because biceps muscle contraction prevents the tendon from healing to the bone without surgery. The resultant weakness without surgery may be acceptable for sedentary individuals but usually is not acceptable for athletic and active individuals. Thus in sports medicine, there is no role for nonsurgical treatment. Surgical treatment usually involves sewing the tendon back to the bone, followed by immobilization in a cast or brace for varying periods. After surgery and immobilization, physical therapy is usually needed to regain elbow and wrist motion and strength.



Medication



• Nonsteroidal antiinflammatory medications, such as aspirin and ibuprofen (do not take for 7 days before surgery), are used to reduce inflammation. Take these as directed by your physician. Contact your doctor immediately if any bleeding, stomach upset, or signs of an allergic reaction occur. Other minor pain relievers, such as acetaminophen, may also be used.

• Pain relievers are usually prescribed after surgery. Use them only as directed, and take only as much as you need.


Heat and cold



• Cold is used to relieve pain and reduce inflammation. It should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

• Heat may be used before performing stretching and strengthening activities prescribed by your physician, physical therapist, or athletic trainer. Use a heat pack or a warm soak.


When to call your doctor



• Symptoms get worse or do not improve in 2 weeks despite treatment.

• You experience pain, numbness, or coldness in the hand.

• A blue, gray, or dusky color appears in the fingernails.

• Any of the following occur after surgery:
Increased pain

Swelling, redness, drainage, or bleeding in the surgical area

Signs of infection (headache, muscle aches, dizziness, or a general ill feeling with fever)

• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
image

Figure 1


From Hislop HJ, Montgomery J: Daniels and Worthingham’s muscle testing: techniques of manual examination, ed 6, Philadelphia, 1995, W.B. Saunders, p 108.

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Jul 19, 2016 | Posted by in SPORT MEDICINE | Comments Off on Biceps Tendon Disruption, Distal

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