Distal Biceps Injuries Non-Surgical Treatment

Nonoperative treatment may be appropriate for patients who:

• Have a partial tear: Many partial tears, particularly those involving less than half of the tendon, improve with nonoperative care.
• Have tendinopathy or bursitis: Irritation of the tendon or surrounding bursa without a significant tear typically responds to nonoperative treatment.
• Have lower physical demands: Patients who do not perform heavy lifting or repetitive forearm rotation may be satisfied with the function they retain.
• Have medical conditions that increase surgical risk: For some patients, the risks of surgery outweigh the expected benefit.
• Have a complete rupture and prefer to avoid surgery: After understanding the expected loss of strength, some patients choose nonoperative care.

Because a completely torn tendon retracts and scars within weeks, the decision between surgical and nonoperative treatment for a complete rupture should be made promptly. Delaying this decision can make a direct repair more difficult or then may require a graft to augment the tissue.

When a complete distal biceps rupture is treated without surgery, the other muscles of the arm take over much of the work, and many patients regain the ability to perform daily activities. However, patients typically lose a meaningful amount of strength, approximately a third or more of the strength to rotate the forearm palm-up and a smaller amount of the strength to bend the elbow. Endurance is also reduced, and some patients experience cramping with repetitive use and a persistent change in the shape of the arm.

For patients with low physical demands, these changes may be acceptable. For active patients, manual laborers, and athletes, the loss of strength and endurance is usually significant enough that surgical repair is recommended.

Nonoperative treatment is an active process that combines several approaches:

• Rest and protection: A short period of rest, sometimes with a sling, allows pain and swelling to settle.
• Ice and anti-inflammatory medications: Help control pain and swelling in the early phase.
• Activity modification: Avoiding heavy lifting, forceful forearm rotation, and repetitive gripping reduces stress on the tendon while it calms down.
• Physical therapy: Therapy begins with restoring elbow and forearm motion, then progresses to strengthening the biceps, the other elbow flexors, and the muscles of the shoulder and forearm to maximize strength and endurance.
• Injections: In select cases of partial tears or tendinopathy, an ultrasound-guided injection, such as platelet-rich plasma (PRP), may be considered. Corticosteroid injections into or around the tendon are generally avoided because they can weaken it. Dr. Rynecki Baker will discuss whether an injection makes sense for you and the evidence behind each option.

Return to activity is gradual and guided by pain, motion, and strength rather than the calendar alone.

Dr. Rynecki Baker follows patients closely during nonoperative treatment.Surgery may be recommended if a patient:

• Continues to have pain or weakness that limits work, sport, or daily activities despite a dedicated course of treatment
• Has a partial tear that progresses or fails to improve
• Finds the loss of strength or endurance after a complete rupture unacceptable
• For partial tears that do not improve, surgery remains a reliable option. For complete ruptures, surgery is still possible later, but it may require a tendon graft once the tendon has retracted and scarred.