Biceps Tendon Repair

What is Biceps Tendon Repair?

Biceps tendon repair is a surgical procedure to restore a biceps tendon that has been torn or ruptured by severe trauma or injury.

The biceps is a large muscle located in the front of your upper arm and runs from the shoulder to the elbow joint. It helps in bending your elbow as well as in rotational movements of your forearm. It also helps to maintain stability of the shoulder joint. The biceps muscle has two tendons, one of which attaches to the bone in the shoulder, and the other to the elbow. A biceps tendon tear can be either partial or complete. Partial biceps tendon tears will not completely cut the tendon. Complete tendon tears sever the tendon into two parts.

Most cases of small or partial ruptures are treated with a nonsurgical approach, whereas a complete rupture will need surgical intervention. The goal of the surgery is to re-attach the torn tendon to the bones in the shoulder and elbow, and to restore normal function of the arm.

Indications for Biceps Tendon Repair

Biceps tendon repair is often indicated for the treatment of a biceps tendon tear due to injuries sustained falling with the arm outstretched, or during the act of lifting a heavy object. In cases of overuse, a tendon may fray and eventually tear. Other shoulder problems such as tendonitis, shoulder impingement, and rotator cuff injuries are likely to weaken or tear the biceps tendon. Additional risk factors such as advancing age, heavy or repetitive overhead activities or sports, smoking, and the use of corticosteroids can also result in a tendon tear.

Preparation for Biceps Tendon Repair

Preoperative preparation for biceps tendon repair may involve the following steps:

• A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
• Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
• You will be asked if you have allergies to medications, anaesthesia, or latex.
• You should inform your doctor of any medications, vitamins, or supplements that you are taking.
• You should refrain from medications or supplements such as blood-thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
• You should not consume any solids or liquids at least 8 hours prior to surgery.
• Arrange for someone to drive you home after surgery.
• A written consent will be obtained from you after the surgical procedure has been explained in detail.

Procedure for Biceps Tendon Repair

The biceps tendon attaches the biceps muscle to the bones in the shoulder and elbow. A biceps tendon tear at the shoulder is called a proximal biceps tendon tear, while a biceps tendon tear at the elbow is a distal biceps tendon tear.

Distal Biceps Tendon Repair

The distal biceps is the area where the biceps attaches to the forearm bone in the elbow. The distal biceps is usually repaired through a single incision (front of the elbow) or a double incision (front and back of the elbow) technique. During the procedure:

• You will be administered general anaesthesia. 
• A small incision is made at the elbow, and the torn or ruptured end of the biceps located. 
• Any damaged tissues are removed using specialised instruments.
• Small holes are then drilled into your forearm bone (radius bone).
• A tiny metal implant known as an anchor is pressed into the forearm bone.
• Strong threads (sutures) are inserted into the distal biceps tendon. 
• The sutures are attached to the anchor and the biceps is pulled back.
• The biceps is reattached and fixed to the forearm bone with strong anchoring stitches.
• The incision is closed with stitches and a dressing is applied.

Proximal Biceps Tendon Repair

The proximal biceps tendon repair is achieved through a procedure called biceps tenodesis. Proximal biceps tenodesis is the surgical reattachment of a torn proximal biceps tendon, which connects the upper part of your biceps muscle to the shoulder.

The surgery may be performed by arthroscopy (keyhole surgery) or open surgery if proximal bicep tenodesis is part of a larger surgery. Proximal biceps tenodesis may involve the following steps:

• You are given general anaesthesia. 
• A tiny incision is made by your surgeon. 
• An arthroscope, which is a thin tube-like instrument with a camera, is inserted through the incision to visualise the joint.
• Your surgeon views the inside of the shoulder joint and the biceps tendon tear on a monitor and performs the necessary surgical repair.
• The injured tendon is detached from the shoulder joint (it may already be detached in the case of a complete tear). 
• The frayed end of the long head of the biceps is clipped off.
• An anchoring device is used to reattach the tendon to the bone. 
• The incision is closed, and a surgical dressing is applied.

Postoperative Care and Recovery

In general, postoperative care and recovery after biceps tendon repair involve the following steps:

• You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anaesthetic reactions and monitor your vital signs as you recover.
• You may need to stay in the hospital for a day or two before discharge.
• You may notice pain, swelling, and discomfort near the surgery site. Pain and anti-inflammatory medications are provided as needed.
• Application of ice packs to the affected area is also advised to prevent stiffness and swelling.
• You are advised to keep your arm elevated above your chest for a few days while resting to decrease swelling and pain.
• You will be placed in a sling or a splint for the first few weeks with instructions on restricted activities.
• You are encouraged to gently exercise your fingers, elbow, and shoulder to prevent stiffness.
• Physical therapy and range-of-motion exercises are recommended after the first follow-up visit to restore mobility and strengthen the elbow and shoulder muscles.
• You should keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
• Refrain from strenuous activities or lifting heavy objects for at least a couple of months. Gradual increase in activities over a period of time is recommended.
• Most patients are able to resume their normal activities in a month or two after surgery; however, return to sports may take 6 to 12 months.
• Do not drive until you are fully fit and receive your doctor’s consent.
• Periodic follow-up appointments will be scheduled to monitor your progress.

Risks and Complications

Biceps tendon repair is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as:

• Pain
• Bleeding
• Infection
• Injury to nerves or vessels
• Anaesthetic/allergic reactions
• Decreased strength and sensation
• Decreased range of motion
• Numbness, tingling, or weakness
• Re-rupture of the repaired tendon
• Need for additional surgery