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Biceps/Triceps Tendon Repairs

Bicep Repair

The biceps muscle is located in front of your upper arm. It helps in bending your elbow as well as in rotational movements of your forearm. Also, it helps to maintain stability in the shoulder joint. The biceps muscle has two tendons, one of which attaches it to the bone in the shoulder and the other attaches at the elbow. The biceps tendon at the elbow is called the distal biceps tendon and if there is a tear in this tendon, you will be unable to move your arm from the palm-down to palm-up position. Once the distal biceps tendon is torn, it cannot regrow back to the bone and heal by itself. Permanent weakness during rotatory movements of the forearm may occur if the tendon is not repaired surgically.

There are several procedures to accomplish reattachment of the distal biceps tendon to the forearm bone. Some techniques require two incisions while in others one incision may be sufficient. In some cases, the tendon is reattached using stitches passed through holes drilled in the bone. Sometimes, a small metal implant may be used to attach the tendon.

Surgical technique

During distal biceps tendon repair, your surgeon makes a small incision over the upper forearm, where the biceps muscle attaches to the radius bone. The torn biceps tendon is brought up through the incision. Then, the radius bone is prepared for tendon reattachment and to promote healing. Two suture anchors will be inserted into the bone. These serve as anchorage for the tendon. The sutures from the suture anchors are passed through the tendon in a particular interlocking manner so as to ensure a strong tendon repair.

After the surgery

After the repair is complete, a hinged elbow brace will be applied with your elbow bent at 90 degrees. The brace will be removed after 6 weeks and it may take up to 6months -1 year to regain full strength.

Risks and Complications

Complications are rare and may include numbness and weakness in the forearm, formation of new bone, limited movement, and re-tearing may occur.

Triceps repair is a surgical procedure that involves the repair of a ruptured (torn) triceps tendon. A tendon is a tough band of fibrous tissue which connects muscle to bone, and works together with muscles in moving your arms, fingers, legs, and toes. The triceps tendons connect the triceps muscles to the shoulder blade and elbow in your arm. Rupture of the triceps tendon is a rare injury which occurs as a result of the detachment of the triceps tendon from the attached bone. These tendons can rupture with lifting heavy weights, during contact sports or after a fall on an outstretched arm.

Triceps Repair

Indications

Triceps repair is indicated for partial or complete rupture of the triceps tendons after trauma or injury. It is also indicated for repairing acute (injuries occurring within four weeks) or chronic (injuries occurring after four weeks) triceps tendon injuries. Distal triceps tendon rupture occurs due to detachment of the triceps tendon connecting the triceps muscles to the elbow. These injuries require immediate medical attention and surgical repair to restore the activity of the triceps muscles.

Pre-procedural preparation

Your surgeon may order blood tests and other essential tests a few days before the surgery. Magnetic resonance imaging (MRI) may be suggested to examine parts of your arm, muscles and blood vessels. X-rays of your shoulder, elbow and arms may be ordered. Your blood pressure, breathing rate, temperature and heart rate will also be recorded. Your shoulder, arm, forearm, and elbow will be cleaned with soap and water and will be covered with sheets before the procedure.

Surgical Procedure

Medications through an intravenous line will be administered to help you relax. The procedure will be performed under general or regional anesthesia to keep you comfortable during the surgery.

Your surgeon will make an incision behind the elbow and drill holes into the end of the ulna (bone in the forearm). The ends of the torn tendons will then be inserted through the holes and stitched. Your surgeon may also use screws and buttons to attach the tendon to the bone. For chronic tendon injuries, a tendon or a hard tissue from another part of the body may be used to lengthen the existing short tendon. After the tendon is attached to the bone, it is sutured and the incisions are closed with surgical tapes or bandages.

Post-operative care

After the procedure, a cast or splint is placed on the elbow to prevent movement and protect the tendon while it heals. After 6 to 8 weeks of surgery, your physical therapist will teach you exercises to be performed at home for improving strength and range of motion in your arm. Contact your doctor if you have a fever >101⁰ or swelling, redness, or drainage from the incision.

Risks and complications

As with any surgical procedure, triceps repair involves certain potential risks and complications. They include:

  • Bleeding and infection at the surgical site
  • Damage to the other parts of the arm, such as muscles, bones, nerves or blood vessels
  • Restricted movement of the arm
  • Difficulty in resuming usual activities or sports

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