Damage to the distal attachment of the biceps tendon

The biceps muscle is located in the front of the shoulder. It is attached to the bones of the shoulder and forearm by tendons - strong fibrous tissues. Distally (in the area of the elbow joint), the biceps tendon is one, and it is attached to the tuberosity of the radius.

In the area of the shoulder joint, there are two tendons (the long and short heads of the biceps), and they are attached to the upper pole of the articular cavity of the scapula and the coracoid process of the scapula, respectively.

Damage to the distal biceps tendon is rare (3-5 cases per 100,000 population, or 2-3% of the total number of shoulder biceps tendon injuries). They are most often caused by a sudden injury and tend to lead to more weakness in the arm than damage to the proximal biceps tendons. The flexion and supination force of the forearm is reduced by 35-40%.

The torn distal tendon of the biceps muscle does not grow to the bone and does not heal. Other arm muscles allow you to bend your elbow quite well without the biceps tendon. However, they cannot perform all the functions of the elbow, especially the movement of turning the forearm from palm down to palm up. This movement is called supination.

To restore arm strength to near-normal levels, surgery to repair a torn tendon is usually recommended. However, non-surgical treatment is a reasonable option for patients who may not need full arm function.

Anatomy < img width="317" alt="suhojile-bitsepsa.jpg" src="/upload/medialibrary/f5c/f5c0af4c257977fbe95a530388b6a6bf.jpg" height="488" title="suhojile-bitsepsa.the biceps muscle has two tendons that attach the muscle to the shoulder and one tendon that attaches it to the elbow. The tendon in the elbow is called the distal tendon of the biceps. It is attached to a part of the radius, the so - called tuberosity-a small protrusion on the bone next to the elbow joint. The biceps helps us bend and turn the arm.

A biceps tendon tear can be partial or complete.

A complete tear completely separates the tendon from the attachment point on the bone. In most cases, ruptures of the distal biceps tendon are complete. This means that the entire muscle separates from the bone and contracts towards the shoulder. Rupture of the biceps tendon of the elbow muscle is rare. 

Reason

The main cause of a torn distal biceps tendon is a sudden injury.

Damage to the biceps tendon in the elbow area usually occurs when the elbow is directed directly against resistance. It is less common to injure this tendon when the elbow is strongly bent against a heavy load.

Lifting a heavy box is a good example. You take weight without understanding the true weight. You strain the muscles and tendons of your biceps, trying to keep your arms bent, but the weight is too much, it causes your arms to straighten. When you resist, the load on your biceps increases and the tendon detaches from the bone.

Risk factors

Most often, the distal biceps tendon is torn by men aged 30 years and older.

Smoking. Nicotine use can affect the strength and quality of tendons.

Corticosteroid medications. Corticosteroid use is associated with increased muscle and tendon weakness.

Symptoms

Rupture of the distal tendon of the biceps muscle causes the muscle to increase asymmetrically closer to the shoulder joint. Bruising and swelling in the elbow are also common.

When a tendon is torn, there is often a "crack" in the elbow. At first, the pain is severe, but after one to two weeks it may subside.

Other symptoms include:

• swelling in the anterior part of the elbow
• visible bruises in elbow and forearm
• weakness in elbow flexion
• weakness when turning the forearm (supination)
• bulge in the upper arm created by a shortened muscle
• absence of tendon subcutaneously in a typical place

After discussing your symptoms and how the injury occurred, your doctor will examine your elbow. It will test the supination strength of your forearm by asking you to turn your forearm against resistance. Your doctor will compare the strength of the supination with the strength of the opposite, intact forearm.

Instrumental examination

Radiography. While an X-ray may not show soft tissues such as the biceps tendon, it can be useful for diagnosing other problems that can cause elbow pain.

Ultrasound. This imaging technique can show the free end of the biceps tendon bouncing off in the arm.

Magnetic resonance imaging (MRI). Better image of soft tissues. It can show both partial and complete ruptures of the biceps tendons.

Treatment

Surgery to attach the tendon to the bone is necessary to restore the full strength and function of the arm.

Non-surgical treatment may be considered if the patient is elderly and less active, or if an injury has occurred on a non-dominant arm and the patient may tolerate a lack of full function. Non-surgical treatment may also be an option for people who have health problems that increase the risk of complications during surgery.

Non-surgical treatment

Non-surgical treatment options are aimed at relieving pain and maintaining the maximum possible function of the arm. Treatment recommendations may include:

< li>restriction of physical activity. Avoid lifting weights and working overhead. To relieve pain and reduce swelling, your doctor may recommend using a kerchief bandage for a short time < li>nonsteroidal anti-inflammatory drugs. Medications such as ibuprofen and paracetamol reduce pain and swelling. < li>physical therapy. Once the pain subsides, your doctor may recommend rehabilitation exercises to strengthen the surrounding muscles to restore as much movement as possible.

Surgical treatment

Tendon repair surgery should be performed within the first 2-3 weeks after the injury. After this time, the tendons and muscles begin to scar and shrink, and it may not be possible to restore the function of the hand during surgery. There are several different methods for attaching the distal biceps tendon to the bone.

The usual surgical option is to attach the tendon with sutures through holes drilled in the radius. Another method is to attach the tendon to the bone using small polymer or metal implants (so-called anchors). Each approach has its own pros and cons.
surgical complications are usually rare and temporary:

< li>numbness and / or weakness of the forearm may occur and usually passes;
• new bone can develop around the place where the tendon is attached to the forearm bone. Although this usually results in a slight restriction of movement, it can sometimes reduce the ability of the forearm to rotate. This may require an additional operation;< / li> < li>the tendon may rupture again after complete healing and recovery.

Immediately after surgery, your arm can be immobilized in a splint. Resistance exercises, such as a light bicep contraction or the use of elastic bands, can be gradually added to your rehabilitation plan.

It takes more than 3 months for the biceps tendon to fully heal, so it is important to protect it by limiting the activity of the arm.

Light work may begin shortly after surgery. But hard work and active activities should be avoided for several months. Adherence to a rehabilitation plan is the most important factor for returning to all the activities you enjoy.

Almost all patients have a full range of motion and strength at their last doctor's visit.