Problem
- The biceps tendon avulses from its insertion on the radial tuberosity
Cause
- Usually a sudden strain to the biceps muscle causes it to tear off the radial tuberosity.
Eg – heavy lifting or tackles
Diagnosis
- The pain is felt initially in the front of the elbow and cubital fossa. Occasionally there is early bruising.
- The biceps muscle migrates slightly proximally and there is an obvious asymmetry between the biceps muscles on both sides.
- Clinical examination shows absence of the taut biceps tendon in the cubital fossa.
- An MRI or ultrasound can help confirm the diagnosis.
Treatment
- Surgical – general anaesthetic
- An incision is made in the forearm and dissection carried out down to the radial tuberosity.
- Occasionally an additional incision is made further in the upper arm to retrieve the tendon, if it is retracted.
- The tendon is then inserted back into the radial tuberosity, through the use of a drill hole and can be secured here, either with suture anchors and endobutton.
- Occasionally, in chronic tears, a palmaris longus graft is required to bridge the gap.
Potential Complications
- Haematoma, neurovascular injury.
- Stiffness to the elbow
- Re-rupture of the repair
Post Op Care
- The patient is normally discharged in a polysling.
- Extension is slowly regained over approximately a six week period.
- Specialist review at ten days for wound inspection and stitch removal.
- Review at six weeks and three months
- Expect return to normal duties by three months
- Aim to improve strength of supination and elbow flexion
