Distal Biceps Repair

There are different options of surgery which will be discussed with you and the best option used.

This involves making a 4 – 5 incision just distal to the elbow crease, sometimes if the tendon is retracted further up the arm then a longer ‘S’ shaped incision across the elbow is used. The retracted biceps tendon is retrieved through the incision. Sometimes another incision higher up the arm may be required to find the tendon.

Strong sutures are threaded through the tendon in an interlocking way to ensure a strong repair of the tendon to the bone. The radius is prepared to encourage healing. A socket is then drilled in the radius near the location of the original attachment. The sutures are then threaded into an anchor which is inserted into the socket with the tendon – performing a tendodesis.

If the tear is chronic then a graft may be required. Sometimes the graft can be harvested from patients forearm (Laceratus Fibrosus) but if this is not possible then a donor graft is used. The graft is stitched into the remainder of patient’s tendon and secured similarly using an anchor. Rarely a second incision on the back of forearm may be necessary.

After surgery the wound is closed with dissolvable sutures tied over the skin. This is then covered with butterfly stitches and a water proof plaster. The arm is then wrapped in a back slab (half cast).

Questions that are often asked

Is the surgery necessary?

The answer is not a straight yes or no; the treatment is tailored to individual patient needs and disability. In acute tear – surgery is carried out if patients feel that they may be left with weakness in the arm / forearm or the appearance.
In chronic cases symptoms of weakness / fatigue or cramping may be present. Also some people do not like the appearance of the ruptured biceps – Reverse Popeye Sign.

Before Admission:

No food for 6 hours, or drink for 2 hours, prior to surgery.
Please avoid smoking for 12 hours prior to surgery.
Please continue to take all your medication as advised by the preassessment team.

What happens on the day of surgery?

You will need to report to the main reception on arrival. You will be shown to your room where you will be checked in by the nurse and also see Prof. Singh and the anaesthetist. This will give you chance to ask any questions before surgery. You will also be given an approximate time of your procedure. Please read the instructions on ‘Preparing for Surgery’.

What are the possible complications?

Complications relating to anaesthesia,
Infection (< 1 in 200)
Stiffness: Mild stiffness is quite common but occasionally a stiff elbow can develop (5%) which will prolong your recovery by a few months.
Pain: This is common for the first few weeks after surgery but steadily settles.
Nerve Damage: The nerves running around the elbow can be damaged during the surgery. A number of patients develop some numbness on the outer aspect of the forearm but this settles over a few weeks. Rarely serious damage could lead to wrist drop and difficulty in using the hand and fingers.
Bleeding: Can cause a collection of blood under the stitches which can cause wound problems. Tell the surgeon if you are on anticoagulants or aspirin
Heterotopic Ossification: This is seen in about 10% patients where new bone is formed around the re-attachment of the tendon. In vast majority of cases it causes minor stiffness and requires a prolonged rehabilitation. In the worst cases the stiffness may restrict daily activities and may even require remedial surgery.

What kind of anaesthesia is used?

Most procedures are done under a general anaesthesia and some patients may require a nerve block. This numbs the arm and helps to control your pain after surgery. The procedure can also be performed with awake anaesthesia – please discuss with your surgeon if you wish to consider.

How long will I be in the hospital?

The surgery is done as a day case and should home within a few hours.

After hospital care:

Backslab: After your surgery, you will be fitted with a back slab (half cast) and high arm sling, which is to be used for 2 weeks.
Medication: The local anaesthetic lasts between 4 to 8 hours. Patients are encouraged to start taking painkillers before the pain starts i.e. on return home and for at least 48 hours. The nerve block usually lasts between 18 – 24 hours.
Wound care &Removal of stitches: At the end of the surgery you have dissolvable sutures to close the skin which are tied over the skin. The sutures will need to be removed at 14 days after surgery which can be performed at your GP practice or nurse at the hospital or by the therapist
Follow-up orthopaedic clinic: You will need to be reviewed in clinic after your operation. This is usually 2 weeks after surgery. You will be put in an elbow brace at 2 weeks either in clinic or by the therapist. You will be in the brace for another 4 – 6 weeks.
Physical Therapy At the time of your surgery you will be referred to a therapist who will help your recovery. A detailed therapy programme will be explained at the time of the surgery.
Return to Work: Managerial or Supervisory: 2– 3 weeks, Light Manual: 4 – 6 weeks (e.g. clerical, secretarial), Heavy Manual: 6 – 10 weeks (ground worker, HGV). Please discuss with your consultant / therapist if you have any queries.
Drivingyou may be able to drive once you are out of the slab, regained some movements and the pain is under control. Please let your Motor Insurance Company aware of your procedure