BICEPS RUPTURE AT THE ELBOW

What is it?

The biceps is a large muscle at the front of the arm. It has two main functions: Bending the elbow and twisting the forearm (used when example turning a screw driver). The muscle arises from the shoulder and inserts into the forearm at the radius by the biceps tendon. When the tendon snaps here at the elbow, it is known as a distal biceps tendon rupture.

What causes it?

It is more common in body builders, weight lifters and strong athletes. It can occur when lifting a heavy weight and the tendon snaps from it’s insertion into the bone. It is more common above the age of 35years. (see video 1)

What are the symptoms?

A snap may be heard when the tendon breaks. This is followed by pain at the elbow. A bulge might form in the arm because the muscle retracts when it is snapped and has been termed the ‘Popeye sign’ as it resembles the cartoon characters arm.

How is it diagnosed?

The specialist can usually diagnose it on clinical examination. There is a deformity of the upper arm with a bulge seen just above the elbow (see Fig.2)

and often bruising develops in the arm and forearm ( see Fig.3). Occasionally, to aid diagnosis, an MRI (Magnetic resonance Image) or Ultrasound scan might be used.

How is it treated?

The treatment of this condition depends on the individual patient. If untreated, patients will lose 30% of power in bending the elbow and 40% loss of power in turning the forearm (supination). This might be more of a problem in the manual worker. Most cases of biceps rupture at the elbow can be treated surgically if picked up early. The surgery involves a day-case procedure (coming in to hospital and leaving on the same day). It will require a general anaesthetic. An incision is made on the front of the elbow (see Fig 3.)

and the tendon is found and attached back to the radius bone in the upper forearm (see Video 2). Depending on the strength of the repair obtained, a plaster of Paris cast may be put on to protect tendon healing for a period of 2-4 weeks. Following this, the elbow can gently be moved with the guidance of the physiotherapist.