Distal Biceps Tendon Disruption

What is Distal Biceps Tendon Disruption

The distal biceps tendon is a strong cord of tissue that connects the biceps muscle, on the front of the upper arm, to a bone (radius) in the elbow.

A distal biceps tendon disruption can interfere with the ability to turn the hand palm-up (supination) and bend (flex) the elbow. This is an uncommon injury that may include one or both of the following:

  • A complete tear (rupture) in the tendon, causing the tendon to completely separate from the radius. When this happens, the biceps muscle pulls up (retracts) toward the shoulder.
  • A partial tear in the tendon that causes the tendon to partially separate from the radius. This is less common than a tendon rupture.

This condition is commonly treated with surgery, and recovery may take 4–8 months. Your health care provider will decide when it is safe for you to return to contact sports.

What are the causes?

This condition is usually caused by suddenly straightening the elbow while the biceps muscle is tightened (contracted). This could happen, for example, while lifting or carrying a heavy object that suddenly falls or shifts position.

What increases the risk?

The following factors may increase your risk of developing this condition:

  • Being a man who is 30–50 years old.
  • Smoking.
  • Using steroids.

What are the signs or symptoms?

Symptoms of this condition may include:

  • Feeling a “pop” in the elbow at the time of injury.
  • Pain, swelling, and bruising in the front of the elbow.
  • Weakness in the arm when doing certain movements, such as:
    • Lifting or carrying objects.
    • Rotating the forearm, such as when you turn a screwdriver.
    • Bending the elbow.
  • A bulge in the upper arm. You may feel this in the front of the arm, the inside of the arm, or both.
  • Limited range of motion of the elbow and forearm.

How is this diagnosed?

This condition is diagnosed based on your symptoms, your medical history, and a physical exam. Your health care provider may test your range of motion by having you do arm movements. You may have tests, including:

  • X-rays.
  • Ultrasound. This uses sound waves to make an image of the affected area.
  • MRI.

How is this treated?

Treatment for this condition usually includes one or more of the following:

  • Resting from sports and intense physical activity.
  • Physical therapy.
  • Surgery to reattach your tendon to your radius. This is the most common treatment method. Your elbow will be kept in place (immobilized) with a cast immediately after surgery.
  • A splint or brace to immobilize your elbow. If you had surgery and you received a cast after surgery, you will get a splint or brace to replace your cast when you start physical therapy.

In some cases, no treatment may be needed for this condition.

Follow these instructions at home:

If you have a splint or brace:

  • Wear the splint or brace as told by your health care provider. Remove it only as told by your health care provider.
  • Loosen the splint or brace if your fingers tingle, become numb, or turn cold and blue.
  • Do notlet your splint or brace get wet if it is not waterproof.
    • If you have a splint or brace, do nottake baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
    • If your splint or brace is not waterproof, cover it with a watertight covering when you take a bath or a shower.
  • Keep the splint or brace clean.

If you have a cast:

  • Do notstick anything inside the cast to scratch your skin. Doing that increases your risk of infection.
  • Check the skin around the cast every day. Tell your health care provider about any concerns.
  • You may put lotion on dry skin around the edges of the cast. Do notput lotion on the skin underneath the cast.
  • Keep the cast clean.
  • If the cast is not waterproof:
    • Do notlet it get wet.
    • Cover it with a watertight covering when you take a bath or a shower.

Managing pain, stiffness, and swelling

  • If directed, put ice on the injured area:
    • Put ice in a plastic bag.
    • Place a towel between your skin and the bag.
    • Leave the ice on for 20 minutes, 2–3 times a day.
  • If directed, apply heat to the affected area before you exercise or as often as told by your health care provider. Use the heat source that your health care provider recommends, such as a moist heat pack or a heating pad.
    • Place a towel between your skin and the heat source.
    • Leave the heat on for 20–30 minutes.
    • Remove the heat if your skin turns bright red. This is especially important if you are unable to feel pain, heat, or cold. You may have a greater risk of getting burned.
  • Move your fingers often to avoid stiffness and to lessen swelling.

Raise (elevate) the injured area above the level of your heart while you are sitting or lying down.

Driving

  • Do notdrive or operate heavy machinery while taking prescription pain medicine.
  • Ask your health care provider when it is safe to drive if you have a cast, brace, splint, or sling on your arm.

Activity

  • Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
  • Avoid activities that cause pain or make your condition worse.
  • Do notparticipate in contact sports until your health care provider approves.
  • Do notlift or carry anything with your injured arm until your health care provider approves.
  • Do exercises as told by your health care provider.

Safety

  • Do notuse the affected limb to support your body weight until your health care provider says that you can.

General instructions

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • If you have a cast or splint, do notput pressure on any part of the cast or splint until it is fully hardened. This may take several hours.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • Your cast, splint, or brace causes pain or numbness.

Get help right away if:

  • You develop severe pain.
  • You develop numbness or tingling in your hand.
  • Your hand feels unusually cold.
  • Your fingernails turn a dark color, such as blue or gray.

Distal Biceps Tendon Disruption Rehabilitation

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your arm. These exercises can also help to relieve pain, numbness, and tingling.

Exercise A: Elbow flexion, passive

1.       Stand or sit with your left / right arm at your side.

2.       Use your other hand to gently push your left / right hand toward your shoulder. Bend your elbow as far as your health care provider tells you to. You may be instructed to try to bend your elbow more and more over time.

3.       Hold for __________ seconds.

4.       Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise B: Supination, passive

1.       Sit with your left / right elbow bent to an “L” shape (90 degrees) and your forearm resting on a table, palm-down.

2.       Keeping your upper body and shoulder still, use your other hand to rotate your left / right palm up. Stop when you feel a gentle to moderate stretch.

3.       Hold for __________ seconds.

4.       Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise C: Pronation, passive

1.       Sit with your left / right elbow bent to an “L” shape (90 degrees) and your forearm resting on a table, palm-up.

2.       Keeping your upper body and shoulder still, use your other hand to rotate your left / right palm down. Stop when you feel a gentle to moderate stretch.

3.       Hold for __________ seconds.

4.       Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Elbow extension, active

Start this exercise only when your health care provider tells you.

1.       Stand or sit with your left / right elbow bent and your palm facing in, toward your body.

2.       Slowly straighten your elbow using only your arm muscles. Stop when you feel a very slight stretch at the front of your arm, or when you reach the position where your health care provider tells you to stop. You may be instructed to try to straighten your arm more and more each week.

3.       Hold for __________ seconds.

4.       Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Elbow flexion, active

Start this exercise only when your health care provider tells you.

1.       Stand or sit with your left / right elbow bent and your palm facing in, toward your body.

2.       Bend your elbow as far as you can using only your arm muscles.

3.       Hold for __________ seconds.

4.       Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise F: Supination, active

Start this exercise only when your health care provider tells you.

1.       Stand or sit with your left / right elbow bent to an “L” shape (90 degrees).

2.       Rotate your palm up until you feel a gentle stretch on the inside of your forearm.

3.       Hold for __________ seconds.

4.       Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise G: Pronation, active

Start this exercise only when your health care provider tells you.

1.       Stand or sit with your left / right elbow bent to an “L” shape (90 degrees).

2.       Rotate your palm down until you feel a gentle stretch on the top of your forearm.

3.       Hold for __________ seconds.

4.       Slowly release and return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise H: Elbow extension, passive, supine

1.       Lie on your back in a comfortable position that allows you to relax your arm muscles.

2.       Place a folded towel under your left / right upper arm so your elbow and shoulder are at the same height.

3.       Use your other arm to raise your left / right arm until your elbow does not rest on the bed or towel. Hold your left / right arm out straight with your other hand supporting it. Let the weight of your hand stretch the inside of your elbow.

o    Keep your arm and chest muscles relaxed.

o    If directed, you may hold a __________ weight in your hand to increase the intensity of the stretch.

4.       Hold for __________ seconds.

5.       Slowly release the stretch.

Repeat __________ times. Complete this exercise __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your arm and shoulder. Endurance is the ability to use your muscles for a long time, even after your muscles get tired. Do notstart any strengthening exercises until told by your health care provider.

Exercise I: Elbow flexion, isometric

1.       Stand or sit with your left / right arm at waist height. Your palm should face in, toward your body.

2.       Place your other hand on top of your left / right forearm. Gently push down while you resist with your left / right arm.

o    Use about half (50%) effort with both arms. You may be instructed to use more and more effort with your arms each week.

o    Try not to let your right / left elbow move.

3.       Hold for __________ seconds.

4.       Let your muscles relax completely before you repeat this exercise.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise J: Elbow extension, isometric

1.       Stand or sit with your left / right arm at waist height. Your palm should face in, toward your body.

2.       Place your other hand on the bottom of your left / right forearm. Gently push up while you resist with your left / right arm.

o    Use about half (50%) effort with both arms. You may be instructed to use more and more effort with your arms each week.

o    Try not to let your left / right elbow move.

3.       Hold for __________ seconds.

4.       Let your muscles relax completely before you repeat this exercise.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise K: Biceps curls (elbow flexion, supinated)

1.       Sit on a stable chair without armrests, or stand.

2.       Hold a __________ weight in your left / right hand. Your palm should face out, away from your body, at the starting position.

3.       Bend your left / right elbow and move your hand up toward your shoulder.

4.       Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise L: Hammer curls (elbow flexion, neutral forearm)

1.       Sit on a stable chair without armrests, or stand.

2.       Hold a __________ weight in your left / right hand, or hold an exercise band with both hands. Your palms should face each other at the starting position.

3.       Bend your left / right elbow and move your hand up toward your shoulder. Keep your other arm straight.

4.       Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise M: Triceps curls (elbow extension)

1.       Lie on your back.

2.       Hold a __________ weight in your left / right hand.

3.       Bend your left / right elbow to an “L” shape (90 degrees) so the weight is in front of your face, over your chest, and your elbow is pointed up to the ceiling.

4.       Straighten your elbow, raising your hand toward the ceiling. Use your other hand to support your left / right upper arm.

5.       Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise N: Elbow extension with exercise band

1.       Sit on a stable chair without armrests, or stand.

2.       Hold an exercise band in both hands.

3.       Keeping your upper arms at your side, bring both hands up to your shoulder. Keep your left / right hand just below your other hand.

4.       Straighten your left / right elbow while keeping your other arm still.

5.       Hold for __________ seconds.

6.       Slowly bend your elbow to return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise O: Supination

1.       Sit with the your left / right forearm supported on a table. Your elbow should be at waist height.

2.       Rest your hand over the edge of the table, palm-down.

3.       Gently grasp a lightweight hammer.

4.       Without moving your left / right elbow, slowly rotate your palm up, to a “thumbs-up” position.

5.       Hold for__________ seconds.

6.       Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise P: Pronation

1.       Sit with your left / right forearm supported on a table. Your elbow should be at waist height.

2.       Rest your hand over the edge of the table, palm-up.

3.       Gently grasp a lightweight hammer.

4.       Without moving your left / right elbow, slowly rotate your palm down.

5.       Hold for __________ seconds.

6.       Slowly return to the starting position.

Repeat __________ times. Complete this exercise__________ times a day.

Distal Biceps Tendon Disruption Rehabilitation After Surgery

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your arm and shoulder. These exercises can also help to relieve pain, numbness, and tingling.

Exercise A: Elbow extension, passive

  1. Stand or sit with your left / right elbow bent and your palm facing in, toward your body.
  2. Straighten your left / right elbow as far as you can using only your arm muscles.
  3. Straighten your elbow farther by gently pushing down on your forearm with your other hand. Do this until you feel a gentle stretch on the inside of your elbow.
  4. Hold for __________ seconds.
  5. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise B: Elbow flexion, passive

  1. Stand or sit with your left / right arm at your side.
  2. Use your other hand to gently push your left / right hand toward your shoulder. Bend your elbow as far as your health care provider tells you to. You may be instructed to try to bend your elbow more and more over time.
  3. Hold for __________ seconds.
  4. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise C: Supination, active

  1. Stand or sit with your left / right elbow bent to 90 degrees.
  2. Rotate your palm up until you feel a gentle stretch on the inside of your forearm.
  3. Hold for __________ seconds.
  4. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise D: Pronation, active

  1. Stand or sit with your left / right elbow bent to 90 degrees.
  2. Rotate your palm down until you feel a gentle stretch on the top of your forearm.
  3. Hold for __________ seconds.
  4. Slowly release and return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

Strengthening exercises

These exercises build strength and endurance in your arm and shoulder. Endurance is the ability to use your muscles for a long time, even after your muscles get tired.

Exercise E: Elbow flexion, isometric

  1. Stand or sit with your left / right arm at waist height. Your palm should face in, toward your body.
  2. Place your other hand on top of your left / right forearm. Gently push down while you resist with your left / right arm.
    • Use about 50% effort with both arms. You may be instructed to use more and more effort with your arms each week.
    • Try not to let your right / left elbow move.
  3. Hold for __________ seconds.
  4. Let your muscles relax completely before repeating this exercise.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise F: Elbow extension, isometric

  1. Stand or sit with your left / right arm at waist height. Your palm should face in, toward your body.
  2. Place your other hand on the bottom of your left / right forearm. Gently push up while you resist with your left / right arm.
    • Use about 50% effort with both arms. You may be instructed to use more and more effort with your arms each week.
    • Try not to let your left / right elbow move.
  3. Hold for __________ seconds.
  4. Let your muscles relax completely before repeating this exercise.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise G: Elbow flexion, supinated

  1. Sit on a stable chair without armrests, or stand.
  2. Hold a __________ weight in your left / right hand, or hold an exercise band with both hands. You palms should face out, away from your body, at the starting position.
  3. Keeping your other arm straight, bend your left / right elbow and move your hand up toward your shoulder. Try not to let your left / right elbow move around while you bend it.
  4. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise H: Elbow flexion, neutral

  1. Sit on a stable chair without armrests, or stand.
  2. Hold a __________ weight in your left / right hand, or hold an exercise band with both hands. Your palms should face each other at the starting position.
  3. Keeping your other arm straight, bend your left / right elbow and move your hand up toward your shoulder. Try not to let your left / right elbow move around while you bend it.
  4. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise I: Elbow extension

  1. Lie on your back.
  2. Hold a __________ weight in your left / right hand.
  3. Bend your left / right elbow 90 degrees so that the weight is in front of your face, over your chest, and your elbow is pointed up to the ceiling.
  4. Straighten your elbow, raising your hand toward the ceiling. Use your other hand to support your left / right upper arm.
  5. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise J: Elbow extension, dynamic

  1. Sit on a stable chair without armrests, or stand.
  2. Hold an exercise band in both hands.
  3. Keeping your upper arms at your side, bring both hands up to your shoulder. Keep your left / right hand just below your other hand.
  4. Straighten your left / right elbow while keeping your other arm still.
  5. Hold for __________ seconds.
  6. Slowly bend your elbow to return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise K: Forearm supination

  1. Sit with your left / right forearm supported on a table. Your elbow should be at waist height.
  2. Rest your hand over the edge of the table, palm-down.
  3. Gently grasp a lightweight hammer.
  4. Without moving your left / right elbow, slowly rotate your palm up, to a “thumbs-up” position.
  5. Hold for__________ seconds.
  6. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise L: Forearm pronation

  1. Sit with your left / right forearm supported on a table. Your elbow should be at waist height.
  2. Rest your hand over the edge of the table, palm-up.
  3. Gently grasp a lightweight hammer.
  4. Without moving your left / right elbow, slowly rotate your palm down.
  5. Hold for __________ seconds.
  6. Slowly return to the starting position.

Repeat __________ times. Complete this exercise__________ times per day.

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