What's the best treatment for a torn biceps tendon at the elbow?

[DonJ]

I am 54 and was lifting a piece of furniture 1 week ago and felt a pop in my arm. My PCP told me I may have torn my biceps tendon, and should see an orthopaedic surgeon.
Although I have a desk job, I am fairly active, and wonder what the pros and cons of surgery are. I do not want an operation if it is not necesary, but by the same token, I want to have reasonable function for the next several years!

[mtomaino]

Historically, ignoring this injury was the norm, and for the most part functional outcomes were reported to be reasonable. As surgical techniques and newer fixation techniques have developed, early surgical intervention has become not only very feasible, but also efficacious. Elbow flexion strength and endurance, and supination strength and endurance can be restored to near normal, with a very low risk of complications. In my experience, patients like yourself have done very well with surgery. By the same token, your pain will settle down without---and your elbow range of motion and flexion strength will be okay.

However, supination and flexion endurance will not return to normal.

When surgery is delayed more than 4-6 weeks, a primary repair may not be possible, in which case options include transfer to the brachialis muscle or reconstruction using allograft tendon. The complication rate is increased slightly for more chronic cases, but functional outcomes, and endurance gains have been supported by the literature.

Complete tears are often diagnosed without an MRI, but in more chronic cases, an MRI can assist in locating how far proximally the tendon has retracted. Further, partial tears can be diagnosed--for which surgical debridement and reattachment are possible when a trial of nonoperative treatment fails.

I use a single incision technique and use a biotenodesis screw and biceps button (Arthrex Inc). This is typiclly outpatient surgery, and performed with a regional anesthesia. After 1, week passive motion is started, and after 3-4 weeks I discontinue a sling--but in most cases a splint is not necessary. Strengthening starts at 8-10 weeks, and unrestricted use can begin at 4 months.