Distal Biceps Repair

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Overview

Distal Biceps Ruptures

A Distal Biceps Rupture is when a tear forms in the tendon connecting the bicep muscle to the radius bone. The result is pain, and a pronounced difficulty flexing and rotating the arm from a palms-down, to a palm-up position. This movement is known as supination.

Your Arm Biceps are: The large muscles in the upper arm that enable you to bend your elbow and rotate your forearm.

The Facts on Distal Biceps Ruptures:

  • Injury and overuse are the most common causes of a bicep rupture.
  • Men between the age of 40 and 60 are at the highest risk.
  • Often a “pop” sound is heard from the elbow at the time of injury.
  • Once the bicep tendon is torn, it does not grow back and reattach to the bone.

 Symptoms

Patients with a distal biceps rupture often report:

  • An unexpected, eccentric extension force applied to the flexed elbow
  • Bruising
  • A bulge in the upper arm
  • A “pop” sound at the elbow
  • A noticeable weakness when flexing the impacted arm
  • Pain when arm is at a 90 degree angle with the palm facing upward

 

Distal Bicep Repair

Evaluation by Team Ahmad

Dr. Ahmad and his team of health professionals will greet you and start your visit with a discussion of your symptoms, sport, level of competition, desired activity level and mechanism of injury. Next, the doctor will exam your biceps, focusing on:

  • Evidence of bruising (ecchymosis)
  • Evidence of tenderness, especially surrounding the biceps muscle and tendon
  • Whether or not the distal biceps tendon can be felt or not
  • Whether or not proximal muscle retraction is seen in the upper arm
  • Weakness when arm is flexed

Dr. Ahmad may request an MRI to confirm the rupture or any degeneration.
 

MRI

Treatment Options

Non-Surgical

A nonsurgical approach is usually considered for:

  • Elderly patients
  • Sedentary patients
  • Patients who wish to avoid surgery
  • Patients who are too ill to undergo surgery

Surgical

Anatomic repair is recommended for patients with a confirmed distal biceps tendon rupture—especially when a patient's partial tears fail to respond to nonsurgical treatment. Dr. Ahmad’s technique is considered the strongest technique and allows for the most rapid healing and return to activity.

During surgery, Dr. Ahmad will:

  • Remove unhealthy parts of the tendon
  • Reattach the tendon to the bone (radial tuberosity) using a metal button

 

radial tuberosity

Dr. Ahmad's Experience

Dr. Ahmad is nationally recognized expert in distal biceps tendon repair surgery and has designed and studied the optimal methods to surgical repair techniques. His undergraduate training in mechanical engineering has allowed him to research the optimal methods of treatment. Dr. Ahmad has performed several hundred elbow surgeries and has treated all types of patients from elite power lifters to recreational athletes who sustained biceps tendon tears.

Listed below is Dr. Ahmad’s scholarly articles and research published to help distal biceps tendon tear treatment.

Dr. Ahmad’s Scholarly Publications Related to Distal Biceps Tendon Tears

Peer Reviewed Scientific Journal Articles
  1. Galdi B, Southren DL, Brabston EW, Popkin CA, Jobin CM, Levine WN, Ahmad CS.Patients Have Strong Preferences and Perceptions for Biceps Tenotomy Versus Tenodesis. Arthroscopy. 2016 Dec;32(12):2444-2450. doi: 10.1016/j.arthro.2016.04.022.PMID: 27318778
  2. Hodgins JL, Kovacevic D, Purcell S, Jobin CM, Levine WN, Ahmad CS. Arthroscopic Suprapectoral and Open Subpectoral Biceps Tenodesis: Radiographic Characteristics. Arthroscopy. 2016 Nov;32(11):2234-2242. doi: 10.1016/j.arthro.2016.03.101. PMID: 27265249
  3. Jobin CM, Kippe MA, Gardner TR, Levine WN, Ahmad CS: Distal Biceps Tendon Repair: A Cadaveric Analysis of Suture Anchor and Interference Screw Restoration of the Anatomic Footprint. American Journal of Sports Medicine, 37: 2214-2221, 2009
Review Articles, Current Concept Articles and Surgical Techniques
  1. Hsu SH, Moen TC, Levine WN, Ahmad CS: Physical Exam of the Athlete’s Elbow. American Journal of Sports Medicine, 40(3) 699-708, 2012
  2. Greiwe MR, Saifi CS, Ahmad CS: Pediatric Sports Elbow Injuries, Clinics in Sports Medicine, 29:677-703, 2010
  3. Ahmad CS, Sutton K, Sethi P, Dodds S: Surgical Treatment of Distal Biceps Ruptures. Journal of the American Academy of Orthopaedic Surgeons, 18 (3) 139-148, 2010
  4. Ahmad CS, ElAttrache NS: Arthroscopic Biceps Tenodesis. Orthopaedic Clinics of North America, 34:499-506, 2003
Textbooks/ Guest Editorship
  1. Ahmad CS, Levine WN, Cadet EC, Editors: Shoulder and Elbow Trauma, JP Medical Ltd, London, 2012
  2. Ahmad CS, Editor: Sports Medicine 2. Instructional Course Lectures Sports Medicine Specialty Volume 2: American Academy of Orthopaedic Surgeons, Illinois, 2011
  3. Levine WN, Ahmad CS, Co-Editors: Current Concepts in Elbow Surgery Part-2 Trauma/Reconstruction. Operative Techniques in Orthopaedics.  Elsevier, Illinois.  Vol 20, pp 1-68, 2010
  4. Ahmad CS, Levine WN, Co-Editors: Current Concepts in Elbow Surgery Part-1 Soft Tissue/Sports. Operative Techniques in Orthopaedics.  Elsevier, Illinois.  Vol 19, 189-264, 2009
Book Chapters
  1. Ahmad CS, Gonzalez-Lomas: “Elbow Injuries in the Athlete” AAOS Comprehensive Orthopaedic Review 2cd edition, edited by Martin Boyer, MD Keener editor of the Shoulder and Elbow section, 2014

AOSSM

  1. AOSSM Annual Meeting, Scientific Session: Elbow: Moderator. Chicago, IL July 2013
  2. AOSSM Annual Meeting, Elbow Ligament Injuries in Throwing Athletes IC 302, Instructional Course, Christopher S. Ahmad MD (New York, NY); Jeffrey R. Dugas MD (Birmingham, AL); Michael G. Ciccotti MD (Philadelphia, PA); George A. Paletta Jr, MD (Chesterfield, MO), Baltimore, MD, July 2012 

Orthopaedics Today Conferences (Moderator)

  1. Orthopedics Today Symposium, Moderator, Sports Elbow Conditions, Lahaina, HI, January 2017
  2. Orthopedics Today Symposium, Moderator, Sports Elbow Conditions, Waikoloa, HI, January 2016
  3. Orthopaedics Today Symposium, Sports Elbow, Moderator, Koloa, Hawaii, January 2015.
  4. Orthopaedics Today Symposium, Clinical Challenge-Part 2 Elbow Controversies, Moderator. The Fairmont Orchid. Kohala Coast, Hawaii. January 2009
Multimedia
  1. Ahmad CS, ElAttrache NS: Athletic Injuries about the Elbow, Orthopaedic Knowledge Online, American Academy of Orthopaedic Surgeons, 2004

AOSSM

  1. Ahmad CS IC 107-Elbow Ligament Injuries in Throwing Athletes. New Techiniques in MCL Reconstruction. American Orthopaedic Society for Sports Medicine Annual Meeting, Seattle WA, July 2014
  2. Ahmad CS, Dugas J, Ciccotti M, Paletta G, Savoie F: IC 204-Elbow Ligament Injuries in Throwing Athletes. American Orthopaedic Society for Sports Medicine Annual Meeting, Chicago, IL, July 2013
  3. AOSSM Annual Meeting, Faculty, IC: Biceps Tendon Injuries: From Shoulder to the Elbow. Providence, RI.  July 2010
  4. AOSSM Annual Meeting, Faculty, IC: Overview of the Athlete’s Elbow, Tendon Problems in the Athlete’s Elbow. Keystone, CO.  July 2009

ASES

Orthopedics Today Symposia

  1. Orthopedics Today Symposium, Faculty, Distal Biceps Rupture: What Technique is Best? Koala, HI, January 2015

 

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