Distal Biceps Tendon Repair: Reattachment of the biceps to the radial tuberosity (Single or Double Incision)

Q1. What is a distal biceps tendon rupture?

The biceps muscle is located in the front of your upper arm and helps you bend your elbow and rotate your forearm (like turning a screwdriver). It is connected to the bones by strong bands of tissue called tendons. The "distal" biceps tendon connects the muscle to a bump on one of your forearm bones called the radial tuberosity. A rupture occurs when this tendon completely tears or pulls away from the bone, usually during a sudden, heavy lifting or pulling action.

Q2. What is distal biceps tendon repair surgery?

Distal biceps tendon repair is a surgical procedure to reattach the torn biceps tendon back to its normal position on the radial tuberosity of the radius bone. Because a completely torn distal biceps tendon does not heal back to the bone on its own, surgery is recommended for active individuals to restore the full strength of elbow flexion (bending) and forearm supination (rotation).

Q3. What is the difference between the single-incision and double-incision surgical techniques?

There are two main surgical approaches:

• Single-incision technique: A single incision is made on the front of the elbow to access the radial tuberosity and reattach the tendon. This approach is common and avoids making an incision on the back of the forearm, though it carries a slightly higher risk of temporary irritation to nearby nerves in the front of the elbow.
• Double-incision technique: An incision is made in the front of the elbow to retrieve the torn tendon, and a second, smaller incision is made on the back of the forearm to safely access the radial tuberosity and secure the tendon. This technique minimizes the risk of nerve irritation but may be associated with bone formation (heterotopic ossification) between the forearm bones. Dr. Veillette will discuss the best technique for your specific injury.

Q4. How is the biceps tendon reattached to the bone?

During the procedure, the radial tuberosity is prepared to create a healthy bone surface for healing. The tendon is then secured to the bone using one of several advanced fixation methods:

• Suture anchors: Tiny screws with attached threads are placed into the bone, and the threads are used to stitch the tendon tightly to the bone.
• Cortical button: A small metal button is passed through a pre-drilled hole in the bone, flipped on the far side, and tensioned to pull the tendon secure.
• Interference screw: A special screw is inserted alongside the tendon into a bone tunnel to wedge it in place.
• Combination: A button and screw are often used together for maximum strength.

Q5. Am I a candidate for distal biceps tendon repair, and what happens if I choose not to have surgery?

Surgery is highly recommended for active individuals, workers, and athletes who require normal arm strength. Without surgery, the tendon will retract (pull up) into the arm, and you will lose about 30% to 40% of your twisting strength (supination) and about 20% to 30% of your bending strength (flexion). Non-surgical treatment is typically reserved for elderly or low-demand patients who are comfortable accepting these permanent strength losses.

Q6. How should I prepare for my surgery?

To prepare for surgery:

• Complete any pre-operative medical testing or bloodwork requested by Dr. Veillette.
• Stop eating and drinking (fasting) by midnight before your surgery.
• Inform us of all medications, herbs, and supplements you take, and follow instructions on which ones to stop (such as blood thinners).
• Arrange for a family member or friend to drive you home and stay with you for the first 24 hours.
• Wear loose, comfortable clothing with wide sleeves that can fit over a bulky splint or brace.

Q7. What type of anesthesia is used during the procedure?

The surgery is usually performed using a combination of general anesthesia (putting you to sleep) and a regional nerve block. A regional block numbs your arm from the shoulder down, providing excellent pain relief that lasts for 12 to 24 hours after surgery. The anesthesiologist will discuss the safest and most comfortable options for you.

Q8. What should I expect on the day of the surgery?

This is typically an outpatient (same-day) procedure. You will arrive at the surgical center, meet the nursing and anesthesia teams, and have the surgical site marked. The surgery itself takes about 1 to 2 hours. After the procedure, you will spend time in the recovery room while the anesthesia wears off, and your arm will be placed in a protective splint or brace.

Q9. Will I need to wear a brace or splint after surgery, and for how long?

Yes. Your elbow must be protected to allow the reattached tendon to heal to the bone. Immediately after surgery, your arm will be placed in a bulky plaster splint or a hinged elbow brace locked in a bent position. The splint is usually removed at your first post-operative visit (around 10 to 14 days), and you may transition to a removable hinged brace that gradually allows more motion over the next 4 to 6 weeks.

Q10. How can I manage pain and swelling after my surgery?

Pain is normal but manageable. Dr. Veillette will prescribe pain medication to help you stay comfortable. Other strategies include:

• Keeping your arm elevated above the level of your heart using pillows, especially for the first 48 to 72 hours.
• Applying ice packs to the elbow for 15 to 20 minutes at a time (keeping the splint or dressings dry).
• Taking pain medication regularly for the first few days rather than waiting for the pain to become severe.
• Gently moving your fingers and shoulder to prevent stiffness and reduce swelling.

Q11. What is the best way to sleep and position my arm post-operatively?

Sleeping in a recliner chair or propped up with pillows in bed is often the most comfortable position for the first week or two. Keep your elbow supported on a pillow to prevent it from dropping backward, and avoid sleeping directly on the surgical arm. Keep the arm in its splint or brace as instructed.

Q12. How do I care for my surgical incision(s) and prevent infection?

Keeping your incision dry and clean is essential:

• Keep the initial surgical splint and bandage completely dry. Wrap it in plastic bags and seal the edges with tape when showering.
• Once the splint is removed by our team, follow specific instructions for washing. Usually, you can let water run gently over the incision, but do not scrub it.
• Never submerge your arm in a bath, pool, or hot tub until the incision is fully healed.
• Monitor for signs of infection, such as increased redness, warmth, swelling, foul-smelling drainage, or a fever over 101.5°F (38.5°C).

Q13. When can I start using my arm and begin physical therapy?

Early, controlled movement is started under the guidance of a physical therapist to prevent stiffness. In the first few weeks, therapy focuses on passive motion (moving the arm with your other hand or having a therapist move it) to protect the healing tendon. Active use of the biceps muscle (bending the elbow on its own) is strictly avoided for the first 4 to 6 weeks.

Q14. What does the rehabilitation timeline look like, and when can I return to heavy lifting or sports?

Healing is a gradual process:

• Weeks 0 to 2: Protection in a splint; finger and shoulder movement.
• Weeks 2 to 6: Transition to a hinged brace; gradual passive range of motion.
• Weeks 6 to 12: Discontinue brace; active movement and light resistance exercises.
• Months 3 to 4: Progressive strengthening of the biceps.
• Months 4 to 6: Gradual return to heavy lifting, manual labor, and sports. Full recovery and maximum strength recovery can take up to 6 to 12 months.

Q15. What are the potential risks and success rates of this surgery?

The success rate for distal biceps tendon repair is very high (over 90% to 95%), with most patients regaining excellent strength and motion. However, as with any surgery, there are potential risks, including:

• Temporary or permanent nerve injury (causing numbness or weakness in the forearm or hand).
• Stiffness or loss of full extension (straightening) of the elbow.
• Re-rupture of the tendon (rare, usually from accidental lifting too early).
• Bone formation in the soft tissues (heterotopic ossification), which can limit forearm rotation.
• Infection or wound healing issues.

We encourage you to write down any specific questions you have and discuss them thoroughly with your surgeon, doctor, or physical therapist. They are your best resource for personalized advice and care.

Disclaimer: This brochure provides general information and is not a substitute for professional medical advice. Always consult your doctor or qualified healthcare provider with any questions you may have regarding your specific medical condition and treatment plan.