Distal Biceps Tendon Repair Overview
Individuals who suffer a distal biceps tendon tear (at the elbow) may wish to consider a surgical distal biceps tendon repair 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 reconstruction, 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 (forearm bone on thumb side) 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 perform a minimally-invasive reconstruction. During a distal biceps tendon repair, a graft (cadaver tissue or hamstring tendon) is used to rebuild the torn biceps tendon. The graft is sewn into the native biceps muscle and then sewn back into the bone. This is a more involved procedure, but it can still result in excellent function in more challenging cases.
Recovery from Distal Biceps Repair
- It is normal to have swelling and discomfort in the elbow for several days and up to a week following your surgery. Apply ice bags 20-30 minutes at a time, every hour or so. Use a thin cloth to avoid burning the skin. Icing is most important in the first 48 hours, although many people find that continuing it lessens their post-operative pain.
- If swelling and pain keep increasing many days after surgery, and you develop a new fever, please call our office immediately.
- Keep the post-op dressing clean and dry. Unless it becomes wet or too tight because of swelling, leave the bandages in place for at least 2 days, then remove them. Cover the small incisions with waterproof bandages to keep them dry. You may shower, but keep the incisions dry for the first 10-14 days. Do not wet your incisions directly or by submerging (bathing or swimming) until at least 2 weeks post-op.
- The sutures are absorbable and do not need to be removed.
- After your elbow surgery, we would like to see you back in the office within 10 days. If you don’t have your first post-operative visit scheduled, call our office to make one.
- Start your post-operative rehabilitation/physical therapy right away. Your physical therapy program is key to a successful outcome. It should be started the day after surgery. A separate prescription will outline the protocol.
- Be in the care of a responsible adult.
- Abstain from drinking alcoholic beverages and from smoking, as these behaviors can impact recovery and delay healing.
- You may eat a regular diet, if not nauseated. Drink plenty of non-alcoholic, non-caffeinated fluids.
- Plan to take a few days off work.
Outcomes and Complications
After a few months almost all patients will have full range of motion and strength, and be able to return to recreational and sporting activities. Complications are very rare from this procedure but may include temporary numbness of weakness in the forearm and re-rupture of the repaired tendon.
Rehabilitation After a Minimally-Invasive Reconstruction of the Distal Biceps Tendon
All distal biceps tears that have been repaired surgically will require time to heal properly. Dr. Millett will ask you to wear a sling after surgery. Sometimes a brace is also needed. Physical therapy can be incorporated during this time. After 6 weeks post-op, strengthening exercises will be initiated to rehabilitate arm function. By four months post-surgery, most patients resume normal activities.
To learn more about distal biceps tendon repair, a minimally-invasive reconstruction procedure, please contact the practice of Dr. Peter Millett.