There are many possible sources of elbow pain. What most have in common is that many people expect these conditions to be something wrong with the elbow itself, whether it is in the name (tennis elbow, golfer’s elbow) or the condition clearly affects elbow structures (cubital tunnel syndrome, bursitis of the elbow). There is one source of elbow pain, however, that may be surprising: a distal biceps tear. Most people think about upper arms in relation to the biceps muscle, but pain near the elbow can be present when the tendon that attaches the biceps to the radius (a bone of the forearm) is injured.
Elbow Anatomy and the Biceps
The biceps muscles are more than just beach muscles. They help control the motion of not one but two joints: the shoulder and the elbow. Although its role in shoulder movement is limited—assisting in moving the arm up, forward and out to the side—it is a vital part of elbow movement. Every time you bring your hand toward your body, the biceps is doing much of the work. It also helps with rotating the forearm as in bringing the hand to the mouth.
The biceps muscle has two heads—that’s what “biceps” means in Latin: two (bi) heads (ceps). Both heads are attached to the upper arm by tendons at the scapula (shoulder blade), though at different parts. That’s what’s known as the proximal end: It is the end closest to the torso. A single tendon attaches both heads to the radius (one of the bones of the forearm) just below the elbow at the distal end. You can easily remember which one is which because the distal end is more distant from the body’s centerline.
Causes and Symptoms of Distal Biceps Tears
When the biceps tendon at the distal end (attached to the radius) of the elbow tears, it is called a distal biceps tear. Unlike more common sources of elbow pain such as tennis or golfer’s elbow, distal biceps tears are almost always caused by acute injury.
Sudden pain usually accompanies the injury and is a strong indication that you’ve experienced a distal biceps tear. Severe ruptures, where the tendon is torn off the bone, leave nothing holding the biceps onto the arm at the distal end. As a result, the biceps muscle may roll up the humerus (upper arm bone) and bunch up near the shoulder. The injury may be accompanied by a pop, and bruising soon after the tear is not uncommon.
Distal biceps tears are not usually completely debilitating. Although the biceps does most of the work flexing the arm—as well as assists in rotating the forearm—other muscles will pick up the slack, usually resulting in more or less full function of the arm. However, arm strength will be severely limited and, because of that, many patients find their quality of life dropping after experiencing a distal biceps tear.
Signs You Need a Distal Biceps Repair
A complete distal biceps tear is a likely culprit if you have experienced one or more of the symptoms detailed above and listed below:
- Sudden pain
- Detachment of the biceps
- A popping sound at the time of injury
- Severe bruising
A doctor will perform a medical history and physical examination to diagnose a distal biceps tear. During the medical history, the doctor will want to know about any recent injuries that may have caused the tear. He or she will be looking for symptoms of a distal biceps tear during an exam.
Imaging scans may be ordered to confirm the diagnosis. An X-ray will not show damage to tendons but can be useful in ruling out other forms of injury or disability such as a fracture. Magnetic resonance imaging (MRI) and ultrasound scans are better able to determine damage to soft tissue.
Treating Distal Biceps Tears
In cases of complete distal biceps tears, the tendon will not heal on its own. The two treatment options are:
- Manage pain symptoms but otherwise no treatment
Because other muscles can perform the duties of the biceps, you will likely still be able to function with a complete distal biceps tear. However, the arm will not be nearly as functional. Generally, you can lose up to 50 to 75 percent of the rotational strength in the arm. For this reason, surgery is usually recommended to most patients to repair a complete distal biceps tear.
Surgery should be performed at most about two to three weeks after the injury—enough time for swelling to go down but not long enough for scar tissue to form on the tendon. Repair typically involves anchoring the tendon directly to the radius.
There are multiple ways to reattach the torn tendon, but two of the most commonly used are through stitching and suture anchors. In the first method, small holes are drilled into the radius. Then the torn tendon is, for all intents and purposes, “sewn” back onto the radius.
The second method is more akin to stapling than sewing. The tendon is reattached to the radius by suture anchors. In both cases, the end of the tendon is trimmed of its raggedness, and the other portion of the tendon (which is not being reattached to the radius) is removed.
Distal Biceps Repair Recovery
Directly after surgery, the arm may be immobilized in a sling for a short period to promote healing. However, your doctor will likely want you to begin moving your arm as soon as possible so that strength and range of motion returns.
Physical therapy can be an important part of the recovery process, speeding up healing. At first, your therapist may have you simply stretch the elbow. As time passes and muscle strength begins to return, you may be lifting progressively heavier weights.
The biceps tendon may take three months or longer to fully heal, according to the American Academy of Orthopedic Surgeons. However, most people who have had distal biceps tendon repair surgery return to full strength, range of motion and arm function.
If you have experienced an elbow injury that exhibits signs of distal biceps tear, request an appointment with one of our sports medicine or shoulder and elbow experts. Our orthopedists will diagnose your injury and recommend a treatment plan to heal your injury as quickly and effectively as possible.