Introduction
The distal biceps tendon attaches the biceps muscle to the bone at the elbow. A distal biceps repair is a procedure to either repair the existing tendon, or to completely reconstruct a replacement tendon. Time is of the essence when repairing a distal biceps tendon – if the biceps tear (also known as a 'rupture') occurred more than 21 days ago, repair can be very difficult, if it is even possible at all.
Preoperative Instructions
- Existing medication(s) – some medications can impact surgery, especially any anti-coagulant medication and medicine for diabetes; we will advise if any of your medication needs to be stopped (and when) well ahead of the day of surgery. Any other medication should be taken the morning of surgery with a little water (half a cup maximum).
- You should not shave (or wax) skin near where any surgical incisions will be made.
- No solid foods (cow's milk and drinks containing cow's milk are considered food) should be consumed within 6 hours of surgery; clear fluids (e.g. water, cordial) may be consumed until 3 hours before surgery and then nil by mouth from that point.
- Please advise us if you have a cold or fever, a cough or any other injuries or infections (e.g. urinary tract infection or cuts / tears to the skin) – your procedure may need to be postponed as any of these may make anaesthesia or surgery unsafe.
- Please bring all imaging (e.g. x-rays / CT scans / MRI scans) with you to hospital.
- Please come to hospital at least one hour before your planned surgery, unless we advise you otherwise.
In very general terms make sure you follow a healthy and balanced diet before surgery and continue any regular physical activity up until the day of the procedure. If you smoke, you should ideally stop smoking at least four weeks before the procedure and otherwise as a minimum at least one week before.
Procedure
There are a number of different approaches to making a distal biceps repair, some reattaching the tendon using sutures and others using metal implants. Access to the tendon site is via a small incision to the upper forearm and the damaged tendon is brought through the incision. The radius bone is then prepared for the tendon to be reattached by drilling a small hole at the insertion point. The tendon is then shuttled into the bone through the hole using a suture and metal button before the incision is closed. The procedure is conducted under a general anaesthetic and takes around 90 minutes to complete.
Postoperative Instructions
This procedure may require an overnight stay in hospital, although in some cases patients are able to return home the same day (in which case they should not drive or return to work the same day). After the procedure the patient must use either a sling or a brace (which keeps the elbow at a 90 degree angle) for around two weeks and after this period active rehabilitation exercises can be started (although gentle stretching exercises are recommended from day one), with strength training starting 3 months after surgery. In the first 6 weeks nothing weighing more than 1 kg should be lifted on the affected arm.
Risks
As with any surgery, with distal biceps repair surgery there is always a risk of:
- Pain.
- Bleeding.
- Scarring.
- Infection (of the incision site, or in the chest).
- Blood clot (leg or lung).
- Stroke.
- Heart attack.
- Damage to nerves / blood vessels.
Specific risks of distal biceps repair surgery include:
- Continued stiffness in the elbow.
- Tendon healing failure.
- Loss of some sensation on the thumb side of the affected arm (although this generally disappears by the 3-month mark).