If you tear your biceps tendon at the elbow, what are the options, how soon is surgery needed, and what are the outcomes?

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.

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. 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.

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