Biceps Tendon Tear Surgery & Recovery

Bob, Choctow, Oklahoma asks:

"I was lifting a very heavy weight and heard a pop in my lower bicep area. I've been told that it is probably a tendon tear. I can still move my arm up and down, but I have lost a significant amount of strength. There was a small amount of swelling at the crook of my arm and there was bruising from my wrist to mid upper arm. Will this require surgery to repair? How long is the recovery? I work out with free weights about 3 times a week."

Marc Bernier at the Alabama Sports Medicine and Orthopaedic Center (ASMOC), replies:

"From the description you have given, it would appear that you have suffered a distal biceps tendon tear. This injury is most commonly caused by a vigorous eccentric contraction (lengthens whilst contracting) of the biceps muscle, similar to the mechanism you have described.

"The symptoms you have reported are textbook for this injury:

a popping felt at the elbow;
localized swelling and bruising at the area;
and a significant loss of strength in elbow flexion and supination.

"The more severe the injury, the easier it is to diagnose. When the tendon is completely ruptured, the biceps muscle will retract towards the shoulder, resulting in a ball-like appearance ½ - ¾ of the way up the arm. The tendon can be partially torn, which appears to be the case in your situation .

Illustration: anatomy of the biceps

"The surgical decision depends on the severity of the injury and the activity level of the patient. In most cases, complete ruptures of the tendon require surgical correction, which involves reattaching the tendon to its insertion site.

"The decision regarding partial tears is a little more involved. The activity level of the patient (low demand vs. high demand) will be one of the primary determining factors. Low demand patients (minimal labor-intensive activities) will typically do well with conservative treatment (rehabilitation). High demand patients will usually require surgery to allow them to return to labor-intensive activities or athletic competition.

"This surgery involves reattaching the torn portion of the tendon. If most of the tendon is torn and is functionally deficient, the surgeon may detach the remaining intact fibers, and perform a complete surgical correction.

"The recovery after reattachment of a complete rupture is a very gradual process, and the speed at which the rehabilitation can be progressed is based on the healing process. Very basic exercises for ROM (Range of Movement) are performed initially for the first 6-8 weeks, followed by light strengthening exercises. These are started with 1 pound weights and gradually increased as strength and symptoms allow. Light weight training can be performed (bench press, shoulder press) at the 3 - 3 ½ month post-op mark. Generally speaking, strength becomes normalized anywhere between the 6-9 month post-op period, which includes a return to full unrestricted function.

"The recovery after a partial tear can be significantly less, but is heavily dependent upon the size of the tear and how much had to be reattached. The physician will typically dictate the post-op progression based on the surgical findings."

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Article published: 25th October 2004