Surgery for Biceps Tendon Disruption (Distal)

with Rehab

Any patient with a complete rupture of their distal biceps tendon is a candidate for surgery to repair the injury. A complete biceps rupture will result in approximately a 30% decrease in elbow bending strength and a 40% decrease in one's ability to rotate the palm upward (supinate). The timing of surgery is very important for one's chances of a complete recovery. Surgery should be performed as soon as possible after injury (usually within 3 weeks). The reason for this is that a delay may result in an inability to reattach the tendon to the bone. The goal of biceps tendon rupture surgery is to regain full function of the biceps muscle.

REASONS NOT TO OPERATE

  • Infection near the site of injury.

  • No functional impairment (sedentary persons).

  • Inability or unwillingness to complete a postoperative rehabilitation program.

RISKS AND COMPLICATIONS

  • Wound infection.

  • Bleeding or injury to blood vessels.

  • Nerve damage resulting in numbness, weakness, or paralysis of the elbow, forearm, and hand.

  • Re-rupture of the tendon from the bone.

  • Elbow or wrist and forearm stiffness and loss of some or all motion at the elbow, wrist, or forearm.

TECHNIQUE

There are multiple surgical techniques that exist for this procedure. A common technique involves two incisions; one in the front to find the tendon and the other on the outer elbow to make a hole (trough) in the bone and sew the tendon into the bone using heavy thread (suture). Another technique requires only one incision in the front of the elbow. This technique reattaches the tendon in the same location it ruptured from by the use of screws or devices similar to toggle bolts (bone anchors). These bone anchors are used to sew the tendon onto the bone with heavy sutures.

HOME CARE INSTRUCTIONS

  • Postoperative management surgery varies depending on the surgical technique and the therapist.

  • The elbow is typically immobilized in a splint, cast, or brace for 3 to 9 weeks.

  • As often as possible, keep the arm and elbow elevated above heart level for the first 1 to 2 weeks after surgery.

  • You will be given pain medications by your caregiver.

  • A sling may be given for comfort after surgery.

  • Postoperative rehabilitation and exercises are very important to regain motion and then strength.

RETURN TO SPORTS

  • The time required before returning to sports depends on the type of sport, the position played, and the quality of ligaments at the time of repair. Your therapist will make this decision.

  • A minimum of 3 to 6 months is necessary after surgery before returning to sports.

  • Full elbow and wrist motion and strength are necessary before returning to sports.

SEEK MEDICAL CARE IF:

  • 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).

Do not eat or drink anything before surgery. Solid food makes general anesthesia more hazardous.

EXERCISES

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

Once your physician, physical therapist, or athletic trainer has permitted you to come out of your brace or splint, you may begin to restore your elbow motion by using these exercises. Beginning these 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), Surgery For

Once your physician, physical therapist, or athletic trainer has permitted you to come out of your brace or splint, you may begin to restore your elbow motion by using these exercises. You will likely begin these exercises no earlier than 8 to 12 weeks after your surgery. 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 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 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.