Description
The biceps muscle is in the front of your arm (see Figure 1). It bends your elbow and twists your forearm to turn your palm upward. The biceps tendon connects the biceps muscle to your radius bone, which is one of the forearm bones. Such maneuverability may lead to distal biceps tendon problems.
Causes
Over time, the biceps tendon can weaken. This is called tendonosis. Tendonosis of the biceps tendon can be painless or it can cause dull or sharp pain in the area of the tendon just past the elbow in the forearm. Tendonosis can lead to tendon tears or tendon rupture. Not all pain in the area of the elbow is caused by biceps tendon problems. There can be other causes for pain in this area.
Biceps tendon tear or rupture can also cause weakness. This can happen without any warning. It often occurs when lifting heavy objects such as furniture. Weightlifters are more likely to experience this injury when doing “negatives,” which is done while holding a weight and extending the arm at the elbow.
Signs & Symptoms
A biceps tendon rupture usually occurs when the tendon tears away from the forearm bones (See Figure 2). This may be felt as a “pop” in the front of the elbow and can be painful. Often, but not always, people feel continued pain, swelling, bruising and warmth in the elbow. Sometimes, people feel a relief from pain that was present before. Muscle spasms in the biceps muscle are common when this happens. Symptoms usually get better over a few weeks. Also, sometimes the muscle can pull up in the arm toward the shoulder. This results in a muscle with a larger-than-normal appearance.
The elbow will usually continue to work after a biceps tendon rupture. This is because there are other muscles that can do part of the job of the biceps muscle. You may experience weakness when flexing the elbow. Most of the weakness after a biceps tendon rupture occurs when twisting your forearm to turn the palm upward, or in supination. You may experience fatigue with repetitive motions if your tendon is not repaired.
There are many medical problems that can make people more likely to have tendon ruptures. Chronic steroid use, whether for medical purposes or when used to gain muscle, is one of the most common reasons for this to happen.
Tendon rupture is most common in men over age 30, but can happen in women too.
Treatment
If the biceps tendon tears completely, it will not grow back to the bone. You must seek care immediately if this occurs since surgery is an option and surgery is best done soon after the injury. If too much time passes, the tendon may not be repairable.
Your surgeon may choose to use imaging, such as an MRI or ultrasound. This can help to diagnose your tear or to plan for surgery. X-rays are often used at the initial visit. X-rays do not show the tendon well, but can be helpful in looking for other causes of elbow pain.
Surgery is not absolutely required for a biceps tendon rupture, but your doctor may suggest it. If your arm is working well after the rupture, you may choose not to have surgery. If you choose to avoid surgery then you should expect permanent weakness and an arm that becomes more easily fatigued.
Surgery is done to reattach the tendon to the bone or to a nearby muscle. There are many different ways surgeons can reattach tendons to bone. Figure 3 shows a repair of the biceps tendon. After surgery, you will require rehabilitation and time to heal. Often, people are able to resume even heavy activities after surgery and rehabilitation.
Figure 1 – The biceps tendon
Figure 2A – Illustration of an acute rupture of the biceps tendon
Figure 2B – Image of an acute rupture of the biceps tendon
Figure 3A – Repair of the biceps tendon
Orthopedic Sports Medicine Center of Oregon is located in Downtown Portland Oregon. Dr. Dominic Patillo, one of our Board-Certified Orthopedic Surgeons, specializes in hand surgery. His practice focuses on the treatment of both simple and complex hand and upper extremity conditions as well as general orthopaedic trauma. He is experienced with modern microsurgical techniques including nerve and vessel reconstruction.
Common problems treated include:
- carpal tunnel syndrome
- tennis elbow
- wrist pain
- sports injuries of the hand and wrist
- fractures of the hand, wrist, and forearm
- trigger finger
Other problems treated can include arthritis, nerve and tendon injuries, and congenital limb differences (birth defects).
If you have pain in your fingers, hand, wrist or arm, or if you have other upper-extremity related concerns, please consult our hand specialist Dr. Dominic Patillo for a consultation.
A Guide to Safety for Young Athletes
in Junior Sports, Sports MedicineArticle Featured on AAOS
For young athletes, sports activities are more than play. Participation in athletics improves physical fitness, coordination, and self-discipline, and gives children valuable opportunities to learn teamwork. Read more
First Good Sam robotic-assisted knee surgery patient excited for future
in Knee Surgery, Technology, Total Knee ReplacementFor as long as she can remember, Janis McClain loves to swim. “I love the water – I love swimming!” exclaims McClain. “I feel it’s totally part of relaxing. It’s the best on my joints – that’s the reason I do it.”
Read moreTHA survivorship with highly crosslinked liners was 93% at 15 years among young patients
in AAAHKS, AnnouncementsData presented at the American Association of Hip and Knee Surgeons Annual Meeting showed total hip arthroplasty performed with a highly crosslinked acetabular liner in patients younger than 50 years of age was associated with Kaplan-Meier overall survivorship of 93% at 15 years when revision due to failure was the endpoint.
“The non-highly crosslinked group showed 87% [survivorship]. This was significantly different,” said Andrew J. Bryan, MD, who presented the results.
Six patients in the group treated with non-highly crosslinked polyethylene and no patients in the group treated with highly crosslinked polyethylene underwent revision surgery, according to Bryan’s presentation.
THA was performed in 273 patients in the study for indications that included osteoarthritis (62%), avascular necrosis (22%) and dysplasia (5%).
“There was no wear in the highly crosslinked group as noted by our method, and there was no osteolysis in the highly crosslinked group,” Bryan said.
The six revisions performed in the non-highly crosslinked polyethylene group (10.5%) were for wear.
According to Bryan, the two groups’ clinical outcomes were similar.
“The use of highly crosslinked polyethylene led to a significant reduction in risk of failure in patients less than 50 years old,” he said. – by Susan M. Rapp
Reference:
Bryan AJ, et al. Paper 22. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 1-4, 2018; Dallas.
Disclosure: Bryan reports no relevant financial disclosures.
Steriod Injections For Arm & Hand Pain
in Steroid InjectionsDescription
Steroid injections can be used to treat some problems in the arm and hand. These can include trigger fingers, tendonitis, carpal tunnel syndrome, arthritis, tennis elbow and rotator cuff tendonitis. These injections usually contain cortisone and a numbing medicine.
Read more
What Is Olecranon Bursitis
in Bursitis, Elbow InjuriesDescription
The olecranon (oh-LEH-cruh-nahn) is the pointy bone at the tip of the elbow. The bursa is the thin sac of fluid that lies between this boney tip and the skin. It helps the skin slide over the bone smoothly. Normally, this sac has only a tiny bit of fluid inside of it and lays flat. However, the bursa can become irritated or inflamed and fill with extra fluid (see Figure 1). When this happens, a painful swelling develops at the back of the elbow. This swelling is olecranon bursitis.
Read more
How To Treat MP Joint Arthritis
in ArthritisDescription
Hand bones are called metacarpals. The finger bones are called phalanges. The metacarpophalangeal joint (MP joint), or knuckle, is where the finger bones meet the hand bones. At the MP joints, the fingers can move in multiple directions. They can bend, straighten, spread apart and move together. MP joints are important for both pinching and gripping.
Read more
What To Do About Shoulder Pain?
in Shoulder InjuriesDescription
The shoulder (Figure 1) is a ball and socket joint that allows a wide range of movement. Because it is composed of several key structures such as tendons, cartilage and bone, the shoulder can be affected by a variety of conditions.
Read more
Gout and Pseudogout – What Is It?
in GoutDescription
Gout and pseudogout are two types of arthritis that result in sore joints. With these types of arthritis, crystals form in the joint, causing irritation that is sometimes also present in the tendons near the joint. Joints can become swollen, painful, and red (Figure 1).
Read more
Do You Have A Ganglion Cyst?
in Arm InjuriesDescription
Ganglion cysts are very common lumps within the hand and wrist that occur adjacent to joints or tendons. The most common locations are the top of the wrist (see Figure 1), the palm side of the wrist, the base of the finger on the palm side, and the top of the end joint of the finger (see Figure 2). The ganglion cyst often resembles a water balloon on a stalk (see Figure 3), and is filled with clear fluid or gel.
CAUSES
The cause of these cysts is unknown although they may form in the presence of joint or tendon irritation or mechanical changes. They occur in patients of all ages.
These cysts may change in size or even disappear completely, and they may or may not be painful. These cysts are not cancerous and will not spread to other areas.
Treatment
Diagnosis
The diagnosis is usually based on the location of the lump and its appearance. Ganglion cysts are usually oval or round and may be soft or firm. Cysts at the base of the finger on the palm side are typically very firm, pea-sized nodules that are tender to applied pressure, such as when gripping. Light will often pass through these lumps (trans- illumination), and this can assist in the diagnosis. Your physician may request x-rays in order to look for evidence of problems in ad-jacent joints. Cysts at the far joint of the finger frequently have an arthritic bone spur—which is a small bony bump or projection—associated with them, the overlying skin may become thin, and there may be a lengthwise groove in the fingernail just beyond the cyst.
Ultrasound or other advanced imaging such as magnetic resonance imaging (MRI) may be helpful in confirming the diagnosis. There are different types of growths that can occur around the and wrist, and additional imaging is sometimes required.
Treatment
Treatment can often be non-surgical. In many cases, these cysts can simply be observed, especially if they are painless, as they frequently disappear spontaneously. If the cyst becomes painful, limits activity, or is otherwise unacceptable, several treatment options are available.
The use of splints and anti-inflammatory medication can be prescribed in order to decrease pain associated with activities.
An aspiration can be performed to remove the fluid from the cyst and decompress it. This requires placing a needle into the cyst, which can be performed in most office settings. Aspiration is a very simple procedure, but recurrence of the cyst is common. If non-surgical options fail to provide relief or if the cyst recurs, surgical alternatives are available.
Surgery involves removing the cyst along with a portion of the joint capsule or tendon sheath (see Figure 3). In the case of wrist ganglion cysts, both traditional open and arthroscopic techniques usually yield good results. Surgical treatment is generally successful although cysts may recur. Your surgeon will discuss the best treatment options for you.
Orthopedic Sports Medicine Center of Oregon is located in Downtown Portland Oregon. Dr. Dominic Patillo, one of our Board-Certified Orthopedic Surgeons, specializes in hand surgery. His practice focuses on the treatment of both simple and complex hand and upper extremity conditions as well as general orthopaedic trauma. He is experienced with modern microsurgical techniques including nerve and vessel reconstruction.
Common problems treated include:
Other problems treated can include arthritis, nerve and tendon injuries, and congenital limb differences (birth defects).
If you have pain in your fingers, hand, wrist or arm, or if you have other upper-extremity related concerns, please consult our hand specialist Dr. Dominic Patillo for a consultation.
Distal Biceps Tendon Problems
in Arm InjuriesDescription
The biceps muscle is in the front of your arm (see Figure 1). It bends your elbow and twists your forearm to turn your palm upward. The biceps tendon connects the biceps muscle to your radius bone, which is one of the forearm bones. Such maneuverability may lead to distal biceps tendon problems.
Causes
Over time, the biceps tendon can weaken. This is called tendonosis. Tendonosis of the biceps tendon can be painless or it can cause dull or sharp pain in the area of the tendon just past the elbow in the forearm. Tendonosis can lead to tendon tears or tendon rupture. Not all pain in the area of the elbow is caused by biceps tendon problems. There can be other causes for pain in this area.
Biceps tendon tear or rupture can also cause weakness. This can happen without any warning. It often occurs when lifting heavy objects such as furniture. Weightlifters are more likely to experience this injury when doing “negatives,” which is done while holding a weight and extending the arm at the elbow.
Signs & Symptoms
A biceps tendon rupture usually occurs when the tendon tears away from the forearm bones (See Figure 2). This may be felt as a “pop” in the front of the elbow and can be painful. Often, but not always, people feel continued pain, swelling, bruising and warmth in the elbow. Sometimes, people feel a relief from pain that was present before. Muscle spasms in the biceps muscle are common when this happens. Symptoms usually get better over a few weeks. Also, sometimes the muscle can pull up in the arm toward the shoulder. This results in a muscle with a larger-than-normal appearance.
The elbow will usually continue to work after a biceps tendon rupture. This is because there are other muscles that can do part of the job of the biceps muscle. You may experience weakness when flexing the elbow. Most of the weakness after a biceps tendon rupture occurs when twisting your forearm to turn the palm upward, or in supination. You may experience fatigue with repetitive motions if your tendon is not repaired.
There are many medical problems that can make people more likely to have tendon ruptures. Chronic steroid use, whether for medical purposes or when used to gain muscle, is one of the most common reasons for this to happen.
Tendon rupture is most common in men over age 30, but can happen in women too.
Treatment
If the biceps tendon tears completely, it will not grow back to the bone. You must seek care immediately if this occurs since surgery is an option and surgery is best done soon after the injury. If too much time passes, the tendon may not be repairable.
Your surgeon may choose to use imaging, such as an MRI or ultrasound. This can help to diagnose your tear or to plan for surgery. X-rays are often used at the initial visit. X-rays do not show the tendon well, but can be helpful in looking for other causes of elbow pain.
Surgery is not absolutely required for a biceps tendon rupture, but your doctor may suggest it. If your arm is working well after the rupture, you may choose not to have surgery. If you choose to avoid surgery then you should expect permanent weakness and an arm that becomes more easily fatigued.
Surgery is done to reattach the tendon to the bone or to a nearby muscle. There are many different ways surgeons can reattach tendons to bone. Figure 3 shows a repair of the biceps tendon. After surgery, you will require rehabilitation and time to heal. Often, people are able to resume even heavy activities after surgery and rehabilitation.
Figure 1 – The biceps tendon
Figure 2A – Illustration of an acute rupture of the biceps tendon
Figure 2B – Image of an acute rupture of the biceps tendon
Figure 3A – Repair of the biceps tendon
Orthopedic Sports Medicine Center of Oregon is located in Downtown Portland Oregon. Dr. Dominic Patillo, one of our Board-Certified Orthopedic Surgeons, specializes in hand surgery. His practice focuses on the treatment of both simple and complex hand and upper extremity conditions as well as general orthopaedic trauma. He is experienced with modern microsurgical techniques including nerve and vessel reconstruction.
Common problems treated include:
Other problems treated can include arthritis, nerve and tendon injuries, and congenital limb differences (birth defects).
If you have pain in your fingers, hand, wrist or arm, or if you have other upper-extremity related concerns, please consult our hand specialist Dr. Dominic Patillo for a consultation.