Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Anterior elbow injuries

Rupture of the distal part of the biceps tendon

The biceps tendon inserts distally into the radial tuberosity in the proximal forearm. It is responsible for flexion in the elbow and also for some supination. The tendon is susceptible to degenerative changes and ruptures occur in athletes over 35 years old. The injury mechanism is usually a sudden extension of the elbow when the elbow is forcefully flexed.

Symptoms and diagnosis

– There is a history of a sudden snap in the elbow region during an eccentric, sudden load of the elbow.
– Moderate pain occurs over the anterior aspect of the elbow.
– Palpation reveals tenderness over the radial tuberosity and the anterior aspect of the elbow.
– Swelling occurs over the distal anterior aspect of the upper arm.
– It is difficult to contract the biceps against resistance at the elbow in the acute stage.
– There is weakness of the elbow in flexion.

Treatment

The athlete should consult a doctor for advice.

The doctor may:
– prescribe careful mobilization with strengthening and stretching exercises (conservative therapy may result in a strength deficit of about 20–40%);
– operate on a complete tear in a young active person. The indication for surgery is the need of the athlete to regain full strength. The procedure consists of reattaching the distal tendon to the radial tuberosity.

Healing

– Early mobilization with strength and stretching exercises can begin as soon as pain and inflammation start to subside.
– Following surgery, healing usually takes 6 weeks, but range-of-motion exercises should start after 2–3
weeks. Strength training can be resumed around 6–8 weeks. Throwing activities are usually not allowed until after 4–5 months. The prognosis and results are good.

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