Individuals who suffer a distal biceps tendon tear (at the elbow) may wish to consider surgery as their primary treatment method. Dr. Millett recommends surgery for active individuals who need to maintain normal arm strength. Surgery helps to restore strength and function and it prevents cramping and retraction of ruptured biceps tendon further up into the arm. If the injury occurs and treatment is delayed, it can be more difficult to repair the biceps tendon because of scarring and loss of the tendon. In some instances a tendon graft from somewhere else in the body or from a cadaver may be needed to reconstruct (rebuild or substitute for) the chronically torn biceps tendon.
In the appropriate individuals, Dr. Millett recommends direct surgical repair of the torn biceps tendon. This is known as a distal biceps tendon repair. This is preferably done right after the injury occurs and swelling has subsided. Dr. Millett prefers to use a minimally-invasive distal biceps tendon repair, single incision approach as this has lower risk of complications and great outcomes. There is not an option for arthroscopic surgery to fix this, but the incision used is very small (less than one inch). Using a single, small incision across the middle of the front of the arm, Dr. Millett uses tiny instruments to enter the arm and grab the disconnected tendon. After removing damaged collagen fibers from the torn end of the tendon, the biceps tendon is reattached to the correct location on the radius (bone) with surgical sutures and special bone anchors.
In more chronic situations where the biceps tendon is actually no longer present, Dr. Millett may opt to use a graft to rebuild the torn biceps tendon and do a distal biceps tendon reconstruction. During a distal biceps tendon reconstruction surgery, a graft, from a cadaver tissue or from the leg using a hamstring tendon, is used to rebuild the torn biceps tendon. The graft is sewn into one’s native biceps muscle and then sewn back into the bone so the biceps muscle will once again properly flex and rotate the elbow. This is a more involved procedure but it can still result in excellent function in these more challenging cases.
Rehabilitation After Distal Biceps Tendon Repair
All distal biceps tears that have been repaired surgically will require time to heal properly. Dr. Millett will have the arm in a sling for a short time. Sometimes a brace is also needed. Physical therapy can be incorporated during this time. After 6 weeks post-op, strengthening exercises will be initiated and functional exercises to rehabilitate the arm.
By 4 months post-surgery, most patients can resume normal activities.