Biceps Tendon Tears at the Elbow: Treatment Options

Biceps Tendon Tears at the Elbow: Treatment Options

For treatment of a torn biceps tendon at the elbow, there are several options available, ranging from nonoperative/conservative treatment to operative interventions. If the injury is left untreated, the symptoms of weakness will remain, and compensatory movements will develop, leading to imbalances in muscles and even posture.

There is a role for nonoperative treatment and the sedentary patient who does not require bending or flexion of the elbow, supination or rotation strength, and endurance of the arm, or the patient who is a poor surgical candidate. Nonoperative treatment consists of temporary immobilization with a sling, pain and anti-inflammatory control with nonsteroidal anti-inflammatory drugs, and physiotherapy to restore range of motion and improve arm strength.

Nonoperative treatment is not often recommended for full tears due to a significant loss in both flexion and rotation strength of the arm that may never fully recover. Because of this, most patients choose surgical treatment. Surgical management fixes the fully torn tendon back to its insertion site on the tuberosity, or bump of the radius bone, and allows it to heal.

These injuries should be addressed relatively quickly to prevent further retraction of the tendon into the upper arm, which can complicate the surgery as well as the patient's recovery. Operative repair has been shown to improve pain and function and is becoming the standard of care in healthy, active individuals.

Surgery is typically performed through an open, single incision in the front of the elbow. For acute or early ruptures, the tendon can be reattached to the bone through a variety of techniques, including sutures, buttons, anchors, and screws. The use of a single metal button anchored from the bone to the tendon by strong sutures is a common modern method, repairs for acute injuries are safer, technically easier, and perform better than for chronic injuries.

Chronic ruptures are much more difficult to treat surgically and sometimes require grafts. They typically present with a stiff, balled-up, and contracted biceps muscle with a shortened, atrophic, or wasted and frayed tendon with quite a bit of scar tissue buildup. Chronic ruptures are treated by a reconstruction procedure where the doctor must use a separate tendon to rebuild the lost tissue of the biceps tendon to attach back to the bone.

After a successful treatment, it is important to follow the doctor's rehabilitation protocol to properly restore function and return to normal activities.