Distal Biceps Repair

What is distal biceps repair?

The biceps muscle is the large muscle in the front of your upper arm. It is attached by strong tendons to the shoulder (proximal end) and to the radius bone below the elbow (distal end). The tendon at the elbow can rupture under very strong contraction of the biceps muscle. This generally occurs in men over 35 years of age, with ‘strength’ athletes, body builders and heavy manual workers being more likely to suffer this condition.

A rupture is considered ‘acute’ if it happened within the past 3 weeks. Beyond this time, repair may be difficult or impossible.  If you think you have ruptured your distal biceps tendon you should seek an orthopaedic opinion as soon as possible.

Distal biceps repair is a surgical procedure to mend or reconstruct a ruptured biceps tendon.

Our specialists at Orthopaedic Clinics Gold Coast will discuss whether this procedure is suitable for you at your visit.

How does distal biceps repair work?

When surgery is indicated for an acute rupture, it needs to be done as soon as possible (ie within three weeks of the injury) to make the surgery technically easier, allow a smaller scar and better tendon healing. If the surgery is delayed, the tendon may retract up the arm making the surgery longer and more difficult.

The tendon is located through an incision over the front of the elbow. It is thenmanipulated down to where it had torn off the radius bone andreattached. The tendon is fixed into place with a small metal button on the other side of the bone and supported with an interference screw. The incisions are then closed and a wound dressing is placed over the area.

What is involved and what to expect with distal biceps repair?

Acute repairs
Day 1 to 2 weeks

After surgery, your arm will be in a sling but you will be able to start your rehabilitation program straight away. Your therapist will go through some exercises with you before you leave the hospital. These include:

  • pain free active flexion and extension within limits of sling
  • full supination and pronation
  • full active shoulder movement with elbow flexion maintained
2–6 weeks

Your exercise program will progress to active range of motion in all directions, to point of mild stretch.

By 6 weeks you should be pain free and have a full range of motion during flexion/extension and rotation. You will probably be able to resume driving and return to work.

6–12 weeks

During this phase, you will:

  • continue with active range of motion exercises
  • introduce light resistance (<2 kg) through full range of motion
  • gradually increase resistance, ensuring to keep movements pain free and well controlled

By 12 weeks your elbow should be quite strong (>90% strength compared to your other arm).

12 weeks +

At this stage you can start biceps strengthening exercises.

Chronic repairs or reconstruction

Day 1 to 2 weeks

After surgery, your arm will be in a sling but you will be able to start your rehabilitation program straight away. Your therapist will go through some exercises with you before you leave the hospital. These include:

  • pain free active flexion and extension within limits of sling
  • full supination and pronation
  • full active shoulder movement with elbow flexion maintained
2–12 weeks

Your exercise program will progress to active range of motion in all directions, to point of mild stretch.

If you have an office-style job, you may be able to return to work during this period. By 6 weeks you should be pain free and have 50–70% extension of range of motion compared to your other arm. You should have full range of motion through flexion and rotation.

12 weeks +

At this stage you can begin using light resistance (<2 kg) and gradually increase the weight as guided by your therapist.

By 12 weeks you should have 80% extension of range of motion compared to your other arm and be able to go back to (manual) work, resume driving, lifting heavier objects and return to golf and contact/impact sports.

6 months +

By 6 months you should have:

  • 90% extension with full range of motion in all other directions
  • 90% flexion strength compared to your other side
  • 80% supination strength compared to your other side.