The distal tendon inserion of the biceps muscle can tear off of the radial tuberosity with a sudden eccentric or concentric contraction. When ths happens, it is not uncommon to hear a pop or perceive a tearing sensation. Elbow flexion strength is retained because of the underlying brachialis muscle, but strength in terms of supination--palm up activity-- will be weak, and there will be limited capacity to generate rotational power or torque.

Historically, nonoperative treatment was advised, and reports published in the 1940s and 1950s show that pain will subside and most function will return. However, torque strength-- the ability to turn wrenches and screw drivers etc-- will be diminished. Because newer techniques allow rattachment of a ruptured biceps, surgery is much more common nowadays.

Though a 2 incision technique has been most popular for a number of years, the newest twist on this surgery has involved a single incision. This has the advantages of fewer complications such as nerve injury or stiffness.

I currently use a single 3-4 cm incision and reattach the biceps tendon using a small metal "endobutton". This technique allows early motion after 10 days, although strengthening is deferred for 8 weeks. After surgery, which lasts 30 minutes, and can be performed under regional anesthesia, the arm is kept in a splint without motion of the elbow for 10 days. At this time I allow motion, with intermittent use of a brace for comfort. Return to normal activity, including lifting, is allowed at 3-4 months.

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