Distal Bicep Tendon Rupture

[TW101]

On September 10, 2008 I had surgery to repair my right (dominent) distal bicep tendon which had ruptured a week previous. I am now 13 weeks post op and in significant pain. My surgeon, who is quite experienced, tells me everything look fine (after xray). I still only have 20% supination after weeks of physical therapy and my arm aches so much at night I get very little sleep. Exercising to regain the supination is painfull but necessary for it to return. I don't know what course of action to take, but know I can't live like this much longer. Any suggestions?

[TW101]

Thanks Doctor Gross -  I did have the  two incision tecnique ... I had the Xray just last week at surgeons office, which did not show any abnormalities. I have recently spoken to someone who indicated that at the same time in his recovery as me (13 wks) he had significant pain as well due to more activity with the repaired arm. He indicated it slowly went away as time went by. I think I'll give it another month or so and if still a major problem, I'll return to my surgeon.

[Michael L Gross, MD]

Distal biceps rupture is a common injury in the athletic population, and almost all orthopedists will recommend surgical repair for this injury.  The results of non-surgical treatment usually are unsatisfactory, with loss of supination (forearm rotation) strength.

Surgery can be performed with either a two incision or one incision technique.  Both approaches have their own set of complications.  The single incision technique has an increased incidence of injury to the radial nerve.  The two incision tecnique can sometimes lead to formation of bridging bone between the radius and ulna (known as a synostosis) which can cause significant loss of motion.  In either technique, a slight loss of supination is not uncommon.

It sounds like you may be forming a synostosis. You mentioned an Xray, but didn't say when it was done.  If it is not in the last six weeks it might be a good idea to repeat it, or even consider a CT scan to look for early bridging bone.  There are several options if it is present ranging from medication to inhibit bone formation, to repeat surgery to try to remove the bone.