Biceps Tendon Disruption (Distal)

with Rehab

The biceps tendon attaches the biceps muscle to the bones of the elbow and the shoulder. A distal biceps tendon disruption is a tear of this tendon at the end the attached near the elbow. A distal biceps tendon rupture is an uncommon injury. These injuries usually involve a complete tear of the tendon from the bone; however, partial tears are also possible. The bicep muscle works with other muscles to bend the elbow and rotate the palm upward (supinate). A complete biceps rupture will result in approximately a 30% decrease in elbow bending strength and a 40% decrease in one's ability to supinate the wrist.

SYMPTOMS

  • Pain, tenderness, swelling, warmth, or redness at the elbow, usually in the front of the elbow.

  • Pain that worsens with flexion of the elbow against resistance and when straightening the elbow.

  • Bulge can be seen and felt in the arm.

  • Bruising (contusion) in the elbow or forearm after 24 hours.

  • Limited motion of the elbow.

  • Weakness with attempted elbow bending (lifting or carrying) or rotation of the wrist (like when using a screwdriver).

  • A crackling sound (crepitation) when the tendon or elbow is moved or touched.

CAUSES

A biceps tendon rupture occurs when the tendon is subjected to a force that is greater than it can withstand, such as straightening the elbow while the biceps is contracted or direct trauma (rare).

RISK INCREASES WITH:

  • Sports that involve contact, as well as throwing sports, gymnastics, weightlifting, and bodybuilding.

  • Heavy labor.

  • Poor strength and flexibility.

  • Failure to warm-up properly before activity.

PREVENTION

  • Warm up and stretch appropriately before activity.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness

  • Allow your body to recover between practices and competition.

  • Learn and use proper technique.

PROGNOSIS

Surgery is usually required to fix distal biceps tendon rupture. After surgery, a recovery period of 4 to 8 months can be expected to allow for healing and a return to sports.

RELATED COMPLICATIONS

  • Weakness of elbow bending and forearm rotation, especially if treated non-surgically.

  • Prolonged disability.

  • Re-rupture of the tendon after surgery.

  • Risks of surgery, including infection, bleeding, injury to nerves, elbow or wrist stiffness or loss of motion, and weakness of elbow bending or wrist rotation.

TREATMENT

Treatment initially consists of ice and medication to help reduce pain and inflammation. A sling may also be worn to increase one's comfort. Surgery is required for a full recovery and return to sports. Surgery involves reattaching the tendon to the bone. Weakness can be expected if surgery is not performed; however, this may be acceptable for sedentary individuals. Surgery is usually followed by immobilization and rehabilitation exercises to regain strength and a full range of motion.

MEDICATION

  • If pain medication is necessary, nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication for 7 days before surgery.

  • Prescription pain relievers may be given if deemed necessary by your caregiver. Use only as directed and only as much as you need.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used prior to performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 weeks despite treatment.

  • You experience pain, numbness, or coldness in the hand.

  • Blue, gray, or dark color appears in the fingernails.

  • Any of the following occur after surgery:

  • Increased pain, swelling, redness, drainage, or bleeding in the surgical area.

  • Signs of infection (headache, muscle aches, dizziness, or a general ill feeling with fever).

  • New, unexplained symptoms develop (drugs used in treatment may produce side effects).

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Biceps Tendon Disruption (Distal)

Once your physician, physical therapist or athletic trainer has permitted you to discontinue using your brace or splint, you may begin to restore your elbow motion by using these exercises. Beginning these exercises before your provider's approval may result in delayed healing. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

RANGE OF MOTION – Extension

  • Hold your right / left arm at your side and straighten your elbow as far as you can using your right / left arm muscles.

  • Straighten the right / left elbow farther by gently pushing down on your forearm until you feel a gentle stretch on the inside of your elbow. Hold this position for __________ seconds.

  • Slowly return to the starting position.

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

RANGE OF MOTION – Flexion

  • Hold your right / left arm at your side and bend your elbow as far as you can using your right / left arm muscles.

  • Bend the right / left elbow farther by gently pushing up on your forearm until you feel a gentle stretch on the outside of your elbow. Hold this position for __________ seconds.

  • Slowly return to the starting position.

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

RANGE OF MOTION – Supination, Active

  • Stand or sit with your elbows at your side. Bend your right / left elbow to 90 degrees.

  • Turn your palm upward until you feel a gentle stretch on the inside of your forearm.

  • Hold this position for __________ seconds. Slowly release and return to the starting position.

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

RANGE OF MOTION – Pronation, Active

  • Stand or sit with your elbows at your side. Bend your right / left elbow to 90 degrees.

  • Turn your palm downward until you feel a gentle stretch on the top of your forearm.

  • Hold this position for __________ seconds. Slowly release and return to the starting position.

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

STRENGTHENING EXERCISES - Biceps Tendon Disruption (Distal)

Once your physician, physical therapist, or athletic trainer has permitted you to discontinue using your brace or splint, you may begin restoring your arm strength by using these exercises. Beginning these before your provider's approval may result in delayed healing. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist, or athletic trainer. Progress the resistance and repetitions only as guided.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does worsen, stop and make certain you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your clinician.

STRENGTH - Elbow Flexors, Isometric

  • Stand or sit upright on a firm surface. Place your right / left arm so that your hand is palm-up and at the height of your waist.

  • Place your opposite hand on top of your forearm. Gently push down as your right / left arm resists. Push as hard as you can with both arms without causing any pain or movement at your right / left elbow. Hold this stationary position for __________ seconds.

  • Gradually release the tension in both arms. Allow your muscles to relax completely before repeating.

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

STRENGTH - Elbow Extensors, Isometric

  • Stand or sit upright on a firm surface. Place your right / left arm so that your palm faces your abdomen and it is at the height of your waist.

  • Place your opposite hand on the underside of your forearm. Gently push up as your right / left arm resists. Push as hard as you can with both arms without causing any pain or movement at your right / left elbow. Hold this stationary position for __________ seconds.

  • Gradually release the tension in both arms. Allow your muscles to relax completely before repeating.

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

STRENGTH – Elbow Flexors, Supinated

  • With good posture, stand or sit on a firm chair without armrests. Allow your right / left arm to rest at your side with your palm facing forward.

  • Holding a __________ weight or gripping a rubber exercise band/tubing, bring your right / left hand toward your shoulder.

  • Allow your muscles to control the resistance as your hand returns to your side.

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

STRENGTH – Elbow Flexors, Neutral

  • With good posture, stand or sit on a firm chair without armrests. Allow your right / left arm to rest at your side with your thumb facing forward.

  • Holding a __________ weight or gripping a rubber exercise band/tubing, bring your right / left hand toward your shoulder.

  • Allow your muscles to control the resistance as your hand returns to your side.

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

STRENGTH – Elbow Extensors

  • Lie on your back. Extend your right / left elbow into the air, pointing it toward the ceiling. Brace your arm with your opposite hand.*

  • Holding a __________ weight in your hand, slowly straighten your right / left elbow.

  • Allow your muscles to control the weight as your hand returns to its starting position.

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

*You may also stand with your elbow overhead and pointed toward the ceiling and supported by your opposite hand.

STRENGTH - Elbow Extensors, Dynamic

  • With good posture, stand or sit on a firm chair without armrests. Keeping your upper arms at your side, bring both hands up to your right / left shoulder while gripping a rubber exercise band/tubing. Your right / left hand should be just below the other hand.

  • Straighten your right / left elbow. Hold for __________ seconds.

  • Allow your muscles to control the rubber exercise band/tubing as your hand returns to your shoulder.

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

STRENGTH – Forearm Supinators

  • Sit with your right / left forearm supported on a table, keeping your elbow below shoulder height. Rest your hand over the edge, palm down.

  • Gently grip a hammer or a soup ladle.

  • Without moving your elbow, slowly turn your palm and hand upward to a "thumbs-up" position.

  • Hold this position for __________ seconds. Slowly return to the starting position.

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

STRENGTH – Forearm Pronators

  • Sit with your right / left forearm supported on a table, keeping your elbow below shoulder height. Rest your hand over the edge, palm up.

  • Gently grip a hammer or a soup ladle.

  • Without moving your elbow, slowly turn your palm and hand upward to a "thumbs-up" position.

  • Hold this position for __________ seconds. Slowly return to the starting position.

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