From the Guidelines
Surgical repair within 2-3 weeks of injury is generally recommended for distal biceps ruptures in active individuals to restore strength and function, as evidenced by recent studies on tendon pathology 1. Management of a bicep rupture typically involves either surgical or non-surgical treatment depending on the severity, location, and patient factors.
Key Considerations
- For proximal biceps ruptures, non-surgical management is often sufficient, focusing on rest, ice, compression, and elevation (RICE protocol), along with NSAIDs like ibuprofen (400-600mg three times daily) for pain and inflammation 1.
- Physical therapy should begin after the acute phase, focusing on progressive strengthening exercises and range of motion.
- Surgical repair involves reattaching the tendon using techniques like suture anchors or bone tunnels, followed by 4-6 weeks of immobilization and then 3-4 months of rehabilitation.
- The decision between surgical and non-surgical management should consider the patient's age, activity level, occupation, and comorbidities, with surgical repair preferred for younger, active patients who require full strength for work or sports 1.
Diagnostic Approach
- 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.
- The flexion-abduction-supination (FABS) MRI view can be performed for distal biceps tendon pathology, allowing for the visualization of the entirety of the tendon on a single image 1.
Treatment Outcomes
- Proper treatment is essential to restore elbow flexion and forearm supination functions, with surgical repair aiming to achieve full strength and function in active individuals 1.
- Non-surgical management may be sufficient for older or less active patients, with a focus on pain management and maintaining range of motion 1.
From the Research
Bicep Rupture Management
- Bicep rupture is a relatively uncommon injury, with distal biceps rupture being less common than proximal biceps rupture 2.
- The majority of distal biceps ruptures can be treated with surgical repair, which achieves comparable improved outcomes and minimal pain and disability at two years 2.
- Surgical repair of distal biceps ruptures is indicated in patients who want to restore supination strength and endurance 3.
- Early surgical repair is recommended for healthy, active persons with distal biceps tendon ruptures, as it results in improved strength in forearm supination and elbow flexion 4.
- The choice of surgical technique remains controversial, with various techniques and fixation devices described in the literature, but no clear evidence of superiority of one technique over another 5.
Treatment Options
- Operative treatment is associated with significantly superior outcomes, including higher flexion strength, supination strength, flexion endurance, and supination endurance, as well as superior patient-reported outcomes 6.
- Nonoperative management may be an option for low-demanding patients, but surgical repair is recommended for young and active subjects who want to restore functional abilities 5.
- The suspensory cortical button technique exhibits maximum peak load to failure in vitro, and suture anchor and interosseous screw techniques yield the least displacement 4.
Rehabilitation
- Safe and effective rehabilitation following distal biceps repair is accomplished through a phased progression, with avoidance of premature stress to the healing soft tissue repair 2.
- Current trends in postoperative rehabilitation include an early return to motion and to activities of daily living 4.
- A valid rehabilitation protocol is essential for excellent results, and the importance of timing for surgery and rehabilitation cannot be overstated 5.