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Dr MARC BEAUCHAMP MD FRCSC
Private orthopedic surgery clinic, Montreal, Canada Shoulder and elbow surgery, arthroscopy
Private orthopedic surgery Montreal, Canada
Elbow Elbow anatomyCommon problemsTendinitis of the elbow, lateral epicondylitisTendinitis of the elbow, medial epicondylitisTendinitis of the elbow, distal bicepsOsteoarthritis of the elbow
Shoulder anatomy

Distal biceps tendinitis and tears

Overtraining or a sudden contraction of the biceps against resistance are usually the cause of this type of injury.

In tendinitis, a deep ache is felt in the hollow of the elbow when bending the elbow or externally rotating the forearm (supination).

If the tendon ruptures, severe pain and a popping sensation will be felt. The biceps muscle sometimes migrates upward and there is often a hematoma on the inside of the elbow.

A rupture must be treated as an emergency; an immediate consultation in orthopedic surgery and imaging tests (MRI or ultrasound) are indicated. In a healthy, active patient, repair surgery should ideally be done within two weeks of the injury. Also, if the patient is not very active, the decision may be made to treat the rupture with physiotherapy alone and the patient will have to accept a certain loss of upper limb strength.

For missed diagnoses, late reconstruction may be attempted, but a tendon will have to be taken from another anatomical site (e.g., fascia lata) and the success rate is lower.

In cases of simple tendinitis, I recommend an MRI scan to ensure that it is not a partial tear. The treatment is rest. Healing can take 6 to 12 months.

Infiltration of the distal biceps tendon should not be performed, for it could cause the tendon to rupture.

"A distal biceps tear is an orthopedic emergency and, if recommended, surgery must be performed within the first weeks of injury."

 

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