What are the symptoms and treatment options for a distal biceps (muscle) tear?

From the Guidelines

Surgical repair within 2-3 weeks of injury is typically recommended for active patients with complete distal biceps tears who want to maintain full strength and function. A distal biceps tear is a rupture of the tendon that connects the biceps muscle to the radius bone at the elbow. Treatment depends on the severity of the tear and patient factors. For complete tears, surgical repair is often necessary to restore strength and function. The procedure reattaches the tendon to the radius bone using suture anchors or bone tunnels 1. Without surgery, patients may experience up to 40% loss of supination strength and 30% loss of flexion strength.

For diagnosis, MRI is particularly useful in the assessment of biceps tears, with improved sensitivity for the detection of partial tears of the biceps and triceps tendons 1. A nonstandard imaging view, the flexion-abduction-supination (FABS) MRI view, can be performed to assess distal biceps tendon pathology. However, the use of US to evaluate the distal biceps tendon is also well described in the literature, with some studies showing that US can be considered an alternative to MRI in the evaluation of distal biceps tendon ruptures 1.

Some key points to consider in the treatment of distal biceps tears include:

• The importance of early surgical intervention for active patients with complete tears
• The use of MRI or US for diagnosis and assessment of the extent of the tear
• The potential for non-surgical management in partial tears or low-demand patients
• The need for gradual rehabilitation and strengthening exercises after surgery
• The potential complications of surgery, including nerve injury, heterotopic ossification, and re-rupture.

In terms of rehabilitation, post-surgical rehabilitation involves wearing a splint for 1-2 weeks, followed by a hinged brace for 4-6 weeks with gradually increasing range of motion. Strengthening exercises typically begin around 6-8 weeks post-surgery, with full recovery taking 4-6 months 1.

From the Research

Distal Biceps Tear Overview

• Distal biceps tears occur most commonly in middle-aged men after a sudden, forced eccentric contraction of the flexed elbow 2.
• The tears typically occur at the distal aspect, where the tendon inserts into the radial tuberosity, and account for about 3% of all biceps tendon ruptures 3.
• Patients usually complain of a sudden, sharp, and painful tearing sensation in the antecubital region, with a palpable defect 3.

Diagnosis and Treatment

• Diagnosis can be made using physical examination tests such as the hook test, the passive forearm pronation test, the biceps crease interval test, and the bicipital aponeurosis flex test 2.
• Treatment options include nonoperative management, repair, and reconstruction with or without repair of the bicipital aponeurosis, depending on the extent and timing of the injury 2.
• Surgical repair has been shown to result in excellent outcomes, with superior elbow and forearm strength and endurance, as well as superior patient-reported outcomes 4.
• Operative management is associated with a significantly higher flexion strength, supination strength, flexion endurance, and supination endurance compared to nonoperative management 4.

Long-term Outcomes

• Long-term outcomes of surgical management of complete tears of the distal biceps tendon have shown high rates of success, with patients maintaining near-normal range of motion and excellent elbow flexion strength 5.
• The overall complication rate was 24%, with common complications including infection, rerupture, heterotopic ossification, reoperation, and nerve complications 5.
• Return to work was 98%, with 85% of those who returned to work doing so without restrictions 5.

Non-Surgical Treatment Options

• Platelet-rich plasma (PRP) injection has been shown to be an effective treatment modality for symptomatic refractory distal biceps tendonitis, with significant improvement in pain and functional outcome 6.
• A single injection of PRP can provide long-term relief of pain and functional impairment, with median follow-up of 47 months 6.