The powerful biceps muscle at the front of the upper arm has two tendon connections at the shoulder and one tendon connection at the elbow. A partial distal biceps tendon tear is an incomplete disruption of the end of the biceps tendon at its insertion point in the elbow. This relatively uncommon injury usually occurs when a bent arm is suddenly forced to straighten, which can happen during sports-related activities or while carrying a heavy object, such as a barbell or refrigerator.
As the distal biceps tendon tears, a painful “popping” sensation may be felt in the inner elbow, with swelling and bruising developing shortly afterward. Because the biceps muscle is no longer firmly secured to the forearm, the biceps muscle may migrate up the arm, producing a visible bulge.
Tendon injuries are notoriously slow to heal. Unlike muscles, tendons do not have a good blood supply, so they do not receive sufficient fluids and nutrients to promote proper healing. Therefore, elbow surgery is the main form of treatment for distal biceps tendon tears, particularly in active patients. Otherwise, some elbow-bending strength and forearm-rotation strength may be permanently lost. Several different surgical techniques can be utilized to provide a good anatomic reinsertion of the biceps tendon. An experienced surgeon can recommend the optimal approach.
An Orthopedic Surgeon on the Leading Edge of Tendon Repair
Christopher C. Schmidt, MD, is a board-certified orthopedic surgeon who practices in Pittsburgh, Pennsylvania. Widely regarded as one of the best shoulder and elbow surgeons in the United States, Dr. Schmidt skillfully performs complex shoulder and elbow procedures and participates in extensive research to continually further his field. Over the years, he has made great strides in improving the surgical repair techniques for tendon injuries, including partial distal biceps tendon tears.
Recently, Dr. Schmidt contributed to a study entitled Partial Distal Biceps Avulsion Results in a Signiﬁcant Loss of Supination Force. The abstract of the study is reproduced below:
Partial Distal Biceps Avulsion Results in a Signiﬁcant Loss of Supination Force
Yoshiaki Tomizuka, MD, Christopher C. Schmidt, MD, Anthony J. Davidson, BS, Christopher S. Spicer, BS, Michael P. Smolinski, BS, Ryan J. Mauro, BS, Sean M. Delserro, MME, Linsey H. Szabo, Patrick J. Smolinski, PhD, and Mark Carl Miller, PhD
Investigation performed at the Shoulder and Elbow Mechanical Research Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Background: Partial avulsions of the short and/or long head of the distal biceps tendon cause pain and loss of strength. The goal of the present study was to quantify the loss of supination and ﬂexion strength following a series of surgical releases designed to simulate partial and complete short and long head traumatic avulsions.
Methods: Mechanical testing was performed to measure supination moment arms and ﬂexion force efﬁciency on 18 adult fresh-frozen specimens in pronation, neutral, and supination. The distal biceps footprint length was divided into 4 equal segments. In 9 specimens (the distal-ﬁrst group), the tendon was partially cut starting distally by releasing 25%, 50%, and 75% of the insertion site. In the other 9 specimens (the proximal-ﬁrst group), the releases started proximally. Mechanical testing was performed before and after each release.
Results: Signiﬁcant decreases in the supination moment arm occurred after a 75% release in the distal-ﬁrst release group; the decrease was 24% in pronation (p = 0.003) and 10% in neutral (p = 0.043). No signiﬁcant differences in the supination moment arm (p ‡ 0.079) or in ﬂexion force efﬁciency (p ‡ 0.058) occurred in the proximal-ﬁrst group.
Conclusions: A simulated complete short head avulsion signiﬁcantly decreased the supination moment arm and therefore supination strength.
Clinical Relevance: A mechanical case can be made for repair of partial distal biceps tendon avulsions when the rupture involves ‡75% of the distal insertion site.
Consult With One of Pennsylvania’s Favorite Physicians
In addition to his unparalleled surgical acumen, Dr. Schmidt is well-known for being friendly and easy to talk to. He has a knack for making his patients feel comfortable and cared for right from the start. This is just one of the many reasons his patients recognize him as one of Pennsylvania’s Favorite Physicians (Patients’ Choice).
If you would like to explore your surgical repair options for a partial distal biceps tendon tear, call (877) 471-0935 to request an appointment with Dr. Schmidt at one of his three office locations in Pittsburgh, PA.
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