From the Guidelines
Surgical repair is the recommended management for complete distal biceps tears, especially in younger, active patients, as it provides better restoration of strength and endurance compared to conservative management 1.
Management Options
The management of distal biceps tears depends on the severity of the tear and patient factors. For complete tears, surgical repair is generally recommended, especially in younger, active patients who require full arm strength for work or recreational activities.
- Surgical options include single-incision or two-incision techniques, with fixation methods including suture anchors, bone tunnels, or cortical buttons.
- Partial tears may be managed conservatively with rest, ice, compression, elevation, NSAIDs (such as ibuprofen 400-600mg three times daily for 1-2 weeks), and physical therapy focusing on gradual strengthening exercises.
Diagnostic Imaging
Diagnostic imaging, such as MRI or US, plays a crucial role in assessing the severity of the tear and guiding management decisions.
- 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.
- US can be considered an alternative to MRI in the evaluation of distal biceps tendon ruptures, with the medial imaging approach demonstrating substantial interreader agreement 1.
Post-Surgical Rehabilitation
Following surgical repair, patients typically wear a splint or hinged brace for 1-2 weeks, followed by progressive range of motion exercises starting at 2 weeks.
- Strengthening exercises begin around 6 weeks post-surgery, with full recovery taking 3-6 months.
- Conservative management is more appropriate for elderly patients, those with low functional demands, or patients with significant comorbidities that increase surgical risks.
Patient Factors
The decision between surgical and conservative management should consider the patient's age, activity level, occupation, comorbidities, and personal preferences.
- Surgical repair generally provides better restoration of strength (particularly supination strength) and endurance compared to non-operative management.
- Patient factors, such as age and activity level, should be taken into account when making management decisions, as they can impact the outcome of treatment 1.
From the Research
Management of Distal Biceps Tear
- The management of distal biceps tear can be either operative or nonoperative, with each approach having its own set of benefits and drawbacks 2, 3, 4, 5, 6.
- Operative management, which involves surgical repair of the distal biceps tendon, has been shown to result in superior outcomes in terms of strength, endurance, and patient-reported outcomes compared to nonoperative management 3.
- A systematic review and meta-analysis found that operative management was associated with significantly higher flexion strength, supination strength, flexion endurance, and supination endurance, as well as superior patient-reported outcomes 3.
- However, nonoperative management may also be effective in certain cases, particularly in patients who are not candidates for surgery or who have minimal functional deficits 6.
- A case report found that two patients with complete distal biceps tendon ruptures were able to achieve full recovery of strength and function through rehabilitation alone, without surgical repair 6.
Treatment Options
- Surgical repair of the distal biceps tendon can be performed using various techniques, including the suspensory cortical button technique, suture anchor technique, and interosseous screw technique 4.
- Nonoperative management typically involves a structured physical therapy program focused on strengthening and stretching the elbow flexors and supinator 6.
- The choice of treatment depends on the extent and timing of the injury, as well as the patient's overall health and activity level 5.
Rehabilitation
- Rehabilitation following distal biceps repair is critical to achieving optimal outcomes, and should involve a phased progression of exercises to avoid premature stress on the healing soft tissue repair 2.
- Early return to motion and activities of daily living is recommended, with a focus on strengthening and stretching the elbow flexors and supinator 4, 6.