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How to Do a Distal Biceps Tendon Repair (Video)

Call 281-633-8600 for an evaluation. In this video, Dr. J Michael Bennett talks about the anatomy of the distal biceps and he explains how a distal biceps rupture can occur. He then describes how to do a distal biceps tendon repair, and he explains why it’s important to get an evaluation early on if you might have a distal biceps injury.

Dr. J Michael Bennett is a Board-Certified Orthopedic Surgeon with offices in Sugar Land and Houston Texas. He’s also a Fellowship-Trained sports medicine specialist. His practice focuses on treating injuries and pathologies of the shoulder, elbow, knee and some hand and wrist injuries like carpal tunnel syndrome.  Dr. Bennett also treats patients for joint issues caused by arthritis.


Here’s the Distal Biceps Tendon Repair video:

Hello my name is Dr. J Michael Bennett. I’m a Fellowship-Trained orthopedic and sports medicine specialist who primarily works on minimally invasive and arthroscopic procedures of the shoulder, elbow, and knee. Today we’re going to talk a little bit about distal biceps injuries and repairs.

First off from an anatomy perspective, the distal biceps is a musculotendinous structure that inserts at the tuberosity of the radius. If you look at the picture here, this is a side view of the elbow, this is the radius, and this little lump here is the tuberosity, and this here is the biceps muscle tendon unit inserting right on the tuberosity.

So if you look at a skeletal structure here of the elbow, the biceps tendon inserts right at this tuberosity, right here, and what the biceps tendon allows you to do, is to flex and allows you to supinate. Supination is the rotation of the wrist and hand and the biceps contributes the majority of your strength with rotation. So it actually helps when you’re using a screwdriver or any kind of motion that involves rotation of the wrist, the biceps is primarily incorporated.

Injuries of the biceps occur primarily when you have two different forces occurring at the same time. When you’re reaching out and trying to grab an object, a heavy object in particular, it involves supination and extension and then flexion to fire the muscles. So if something is falling quickly and you reach out to catch it, that involves all those movements.

That, if you’re not expecting it and you have any kind of tendinitis or injury to the distal biceps, can put that biceps tendon under significant stress and can lead to a tear or rupture in the biceps. So if you did have an injury like I’m describing there and you felt a pop or snap or significant pain in this region here, this is called antecubital fossa, then you may very well have a biceps injury. It usually followed by swelling and bruising in this region.

Sometimes you may also notice a deformity because as this biceps is torn, it can actually retract and coil up and actually retract upwards, and that actually causes the shortening of that musculature there, and you can see a deformity if you look at your biceps and you compare to the other side, there’s an obvious deformity. Another way you can test to see if your biceps or is ruptured or not, is to rotate your hand and you see the tendon or the muscle tendon unit, rise and lower with rotation. If it’s doing it on one side and not the other side, you will know that there’s an injury to the biceps. This is looking at it from the side view and this looking at it from the front view of your elbow.

When you disrupt it from the front view the same thing happens. It ruptures, coils and retracts. And it goes upward. Now the key with biceps ruptures is to get it evaluated early. Because these can be treated and they can be treated surgically. The way that we surgically treat biceps ruptures, is we pull this biceps tendon back down and we then we fixate it back to the tuberosity. The way we fixate it back to the tuberosity is with two anchors, little anchors into the bone with stitches that run up the biceps tendon. And that gives it added support and you tie it up top there, and it pulls that tendon back down to its normal position here at the tuberosity. The reason we use anchors is because it’s bone sparing, I like to leave as much bone intact as possible when were doing a repair at the biceps tendon.

Now if you do not get these addressed early, what happens is that the muscle continues to retract and the tendon continues to retract and it become very difficult to pull it back down. Tendons have excursion or flexibility when you pull them down. If they are retracted for long periods of time, they actually turn to scar tissue and it can be very difficult to pull it back down. And sometimes we have to use a graft to augment the repair and to give you a solid repair. And sometimes we have to use a cadaver graft where we actually lay down an additional graft on top of your tendon and sew those two together to give you good fixation if we can’t get that tendon back down. So we recommend highly if you think you have a biceps injury to get it evaluated by an orthopedic specialist for an x-ray and possibly an MRI and the MRI will tell us in addition to the physical exam whether or not you have a distal biceps injury.

Go to our website at or or feel free to call the office at 281-633-8600 for an evaluation. Thank you.

If you feel that you might have a distal biceps injury, it’s very important to get it evaluated early. Call our office at 281-633-8600 to make an appointment with Dr. Bennett. As explained in the video, the distal biceps tendon repair becomes more complex if you wait before seeking care. You can make an appointment by clicking the book an appointment button in the upper right-hand corner of the page or by calling our office.

Dr. J. Michael Bennett

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