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Elbow FAQ

Question:

I am an anatomy instructor in my first teaching year looking for any information you may have on biceps tendon tears. My hope is to provide a lecture that covers both the anatomy with some information on what happens during and after tendon injuries. What can you recommend?

Answer:

There is a recent review of distal biceps tendon ruptures that may be of interest to you. In this article, hand surgeons from the University of Pittsburg Department of Upper Extremity Reconstructive Surgery provide an update on this problem. The "new news" about distal biceps tendon injuries has come about for three reasons: 1) Technology has made it possible to discover new understanding about the biceps tendon anatomic form and function. 2) Thirty years of improvements have been made on surgical techniques to reduce complications following surgery and to improve strength of the repair (referred to as tendon-to-bone fixation). 3) Studies over the last 30 years (since the mid-1980s) have given us enough data to see long-term results of both conservative (nonoperative) care and surgical management. As you will appreciate, a discussion of form and function (mentioned in number one above) can be the topic of just one lecture alone. In this topic, the authors include the structure of the biceps tendon, "footprint" (where and how it attaches to the bone), and biomechanics (how it contracts and relaxes to create movement). Data mentioned in number three above has been collected on both acute and chronic injuries as well as partial and complete tears of the distal biceps tendon. Through a series of illustrations, photos, and imaging studies (MRIs, X-rays), the authors will bring you up-to-date on the basic science of biceps tendon, repair biology (how it heals), and the diagnosis of partial versus complete tears. The same approach is used to describe current methods of treatment. Here are a few highlights of new findings that may be of interest to you:
  • The distal biceps tendon is two unique and separate units. This understanding replaces the former belief that there were two units that blended together to form one at the insertion point to the bone.
  • Accurate surgical reattachment of the two tendon subunits to the bone must be done carefully. Anterior placement (forward of the original footprint) is no longer preferred. To gain the best results, the tendon must be reattached at its original anatomic site.
  • A posterior surgical approach is recommended. This technique gives the surgeon access to the footprint and allows for placement of the anchor or button (a fixation device used to hold the tendon in place) in an anatomic position.
  • Many patients heal with additional bone forming in the soft tissue. This effect called intrasubstance heterotopic bone does not seem to adversely affect final outcomes.
  • Partial tears are still treated conservatively at first; surgical repair can be saved for later if the nonoperative approach fails to give the desired results. Patients can expect some loss of strength and motion of the forearm/elbow with conservative care.
  • Chronically torn distal biceps tendons should be repaired with the elbow fully flexed (bent); this technique has been shown to decrease the need for a tendon graft. In addition to the details listed above, you will find information in this article about complications, complication rates, advice regarding surgical techniques, and pros and cons of conservative care versus surgical intervention. Summaries of treatment results from past studies on this topic of distal biceps tendon injuries and treatment are also provided. This should give you plenty of ammunition for your lecture! Christopher C. Schmidt, MD, et al. The Distal Biceps Tendon. In The Journal of Hand Surgery. April 2013. Vol. 38A. No. 4. Pp. 811-821.

    *Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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