From the Research
Bicep tendon ruptures can be repaired, but they typically don't return completely to normal, with surgical repair offering the best chance of restoring function, especially for complete tears of the distal biceps tendon (at the elbow) 1. Surgical repair is most effective when performed within 2-3 weeks of injury, and the procedure involves reattaching the tendon to the radius bone using suture anchors or bone tunnels. After surgery, patients follow a rehabilitation protocol that includes 1-2 weeks in a splint, followed by progressive physical therapy for 3-6 months. While most patients regain about 80-95% of their original strength and function, some permanent loss of strength (particularly in supination - palm-up rotation) is common even with optimal treatment, as shown in a study that found operative management was associated with a significantly higher flexion strength and supination strength compared to nonoperative management 1. Non-surgical management is an option for partial tears or for proximal (shoulder) tears in less active individuals, but typically results in 30-40% permanent strength deficit. The reason complete restoration isn't possible is that the repaired tendon develops scar tissue at the repair site, which lacks the elasticity and structural integrity of the original tendon-bone junction. A recent systematic review and meta-analysis found that operative treatment resulted in superior elbow and forearm strength and endurance, as well as superior patient-reported outcomes, compared to nonoperative management 1. Additionally, a study on return to sport after distal biceps tendon repair found that patients had excellent functional outcomes, with a high rate of return to sport at 6 months postoperatively, and that trends associated with a higher return to sport rate were observed with bone tunnel fixation, early initiation of active range of motion, and initiation of strengthening at ≤10 weeks 2. Key points to consider in the management of bicep tendon ruptures include:
- Surgical repair is the best option for complete tears of the distal biceps tendon
- Early intervention (within 2-3 weeks of injury) is crucial for optimal outcomes
- Rehabilitation protocols should include progressive physical therapy for 3-6 months
- Non-surgical management may be suitable for partial tears or proximal tears in less active individuals, but typically results in significant permanent strength deficit. It is essential to weigh the benefits and risks of each treatment option and consider individual patient factors, such as age, activity level, and overall health, when making a decision about how to manage a bicep tendon rupture. In general, the goal of treatment should be to restore function and strength to the affected arm, while minimizing the risk of complications and promoting optimal outcomes, as supported by the most recent and highest quality study available 2.