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Biceps Tendon Repair in India

Surgical repair of torn biceps tendon to restore arm strength and function. Essential for athletes and active individuals seeking full recovery.

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Overview

Biceps tendon repair is a surgical procedure to reattach a torn or ruptured biceps tendon to the bone. The biceps muscle has two tendons that attach it to the shoulder (proximal) and one tendon that attaches to the elbow (distal). Tears most commonly occur at the shoulder, particularly the long head of the biceps tendon, though distal biceps ruptures at the elbow are also significant injuries requiring prompt surgical intervention. At Arthroscenter, Dr. Gurudeo Kumar specializes in both arthroscopic and open biceps tendon repair techniques, having successfully performed over 150 biceps tendon surgeries. Our advanced surgical approaches minimize scarring, reduce recovery time, and maximize strength restoration. We utilize modern fixation techniques including suture anchors and interference screws to ensure secure tendon reattachment. This procedure is particularly important for athletes, manual laborers, and active individuals who require full arm strength and function. While proximal biceps tears can sometimes be managed conservatively, distal biceps ruptures typically require surgery within 2-3 weeks of injury for optimal outcomes. The surgery typically takes 1-2 hours and most patients regain 90-95% of their original strength within 6 months.

Symptoms & Indications

This surgery may be recommended if you experience:

Sudden sharp pain in the upper arm or elbow during heavy lifting

Audible "pop" sound at the time of injury

Visible bulge in the upper arm (Popeye deformity) with proximal tears

Bruising that spreads down the arm from the shoulder or elbow

Weakness in shoulder or elbow flexion and forearm supination

Difficulty bending the elbow or rotating the forearm

Pain and tenderness at the shoulder or elbow crease

Cramping sensation in the biceps muscle with use

Inability to perform pull-up or chin-up movements

Loss of arm definition and muscle contour changes

Procedure Details

Duration

1-2 hours depending on technique and tear location

Anesthesia

Regional nerve block (interscalene for shoulder, axillary for elbow) with sedation or general anesthesia

Preparation for Surgery

Patients undergo physical examination, MRI or ultrasound imaging to confirm the tear location and extent. Pre-operative assessment includes medical history review, blood tests, and discussion of surgical technique. Patients are advised to arrange transportation and post-surgery assistance, stop blood-thinning medications if cleared by their physician, and fast 8 hours before surgery.

Surgical Steps

Regional nerve block or general anesthesia is administered for pain control

For proximal repairs: Small incisions are made for arthroscopic access to the shoulder, or an open incision if tenodesis is performed. The torn tendon end is identified and prepared

For distal repairs: A 3-5 cm incision is made in the elbow crease. The radial nerve is carefully identified and protected throughout

The tendon is retrieved and any damaged tissue is debrided to healthy tendon fibers

For proximal tears: The tendon is reattached to the bone using suture anchors (tenodesis) or fixed within the bicipital groove (tenotomy may be chosen for older patients)

For distal tears: The radial tuberosity is prepared and the tendon is secured using either suture anchors or the Endobutton cortical fixation technique

The repair is tested for strength and appropriate tension, ensuring full elbow range of motion

Incisions are closed in layers with absorbable sutures, surgical glue or staples are applied, and sterile dressings are placed. A sling is applied for arm protection

Recovery Timeline

What to expect during your recovery journey

Week 0-2

Immobilization Phase

Arm kept in sling at 90 degrees. Only gentle hand, wrist, and finger exercises allowed. Ice therapy and pain medication. No active elbow or shoulder movement. Focus on reducing swelling and protecting the repair.

Week 2-6

Passive Range of Motion

Begin gentle passive elbow and shoulder exercises with physiotherapist guidance. Sling use continues but may be removed for exercises and activities of daily living. Light grip strengthening begins. No lifting or resistance activities.

Week 6-12

Active Range of Motion

Start active elbow flexion and extension exercises without resistance. Gradually discontinue sling use. Progress to light activities of daily living. Begin gentle stretching to prevent stiffness. Still no heavy lifting or forceful movements.

Week 12-16

Strengthening Phase Begins

Progressive resistance exercises introduced with therapy bands and light weights (1-2 kg). Focus on biceps, forearm, and shoulder strengthening. Gradual return to work for desk jobs. Continue physiotherapy 2-3 times per week.

Month 4-6

Advanced Strengthening

Increase resistance training progressively up to 5-8 kg. Sport-specific exercises for athletes. Return to most daily activities and light manual work. Continued focus on flexibility and endurance building.

Month 6-12

Return to Full Activity

Gradual return to unrestricted activities including sports and heavy lifting. Maintenance exercises continue. Most patients achieve 90-95% strength recovery. Full healing of tendon to bone complete by 9-12 months.

Tips for Faster Recovery

Wear the sling religiously for the first 6 weeks to protect the repair

Apply ice packs 15-20 minutes every 2-3 hours for the first week to reduce swelling

Keep the surgical site clean and dry; follow wound care instructions carefully

Perform only prescribed exercises; avoid any unauthorized arm movements

Sleep in a semi-reclined position with arm supported for the first 2-4 weeks

Attend all physiotherapy sessions without fail; rehabilitation is crucial for success

Never lift anything heavier than a cup of coffee for the first 6 weeks

Avoid repetitive gripping, pulling, or pushing movements until cleared by your surgeon

Report any signs of infection, increased pain, numbness, or unusual swelling immediately

Be patient with recovery; tendon healing takes time and rushing can cause re-rupture

Frequently Asked Questions

Common questions about this procedure

Q1.What is the difference between proximal and distal biceps tendon tears?

Proximal biceps tears occur at the shoulder where the long head of the biceps tendon attaches. These are more common (90% of cases) and can sometimes be managed non-surgically, especially in older or less active patients. Distal biceps tears occur at the elbow where the tendon attaches to the radius bone. These are less common but almost always require surgery for full strength recovery, particularly in active individuals. Distal tears result in significant weakness in forearm supination (turning palm up) and elbow flexion strength loss of 30-40% if not repaired.

Q2.How urgent is biceps tendon repair surgery?

For proximal tears, surgery can be delayed for several weeks to months while considering conservative options. However, for distal biceps ruptures, timing is critical. Surgery should ideally be performed within 2-3 weeks of injury for optimal results. After 4-6 weeks, the tendon begins to retract and scar, making repair more difficult and outcomes less predictable. At Arthoscenter, Dr. Kumar prioritizes urgent scheduling for distal biceps injuries to ensure the best possible recovery.

Q3.What is the Popeye deformity and does it need surgery?

The Popeye deformity is a visible bulge in the upper arm caused by the biceps muscle bunching up when the proximal long head tendon ruptures. While cosmetically noticeable, many patients (especially older, less active individuals) can function well without surgery. Conservative treatment results in about 20% loss of supination strength and 10% loss of elbow flexion strength. Surgery is recommended for younger, active patients, athletes, or those whose occupation requires full arm strength. Dr. Kumar helps each patient decide based on their individual lifestyle and functional needs.

Q4.Can I regain full strength after biceps tendon repair?

Most patients regain 90-95% of their original strength with proper surgical repair and dedicated rehabilitation. Athletes and highly motivated patients often achieve near-complete strength recovery. Factors affecting recovery include age, timing of surgery (earlier is better), surgical technique, and compliance with physiotherapy. Distal repairs typically achieve better strength outcomes than proximal repairs. At Arthoscenter, our comprehensive rehabilitation protocol maximizes strength recovery for all patients.

Q5.What are the risks of biceps tendon repair surgery?

Complications are uncommon but can include infection (less than 1%), nerve injury (particularly the lateral antebrachial cutaneous nerve in distal repairs or radial nerve), heterotopic ossification (abnormal bone formation), stiffness, re-rupture (1-2%), and chronic pain. Using modern surgical techniques and experienced surgeons like Dr. Kumar significantly reduces these risks. The overall complication rate at Arthoscenter is less than 3%, which is well below national averages.

Q6.How is biceps tendon repair different from biceps tenodesis?

Biceps tendon repair refers to reattaching the torn tendon to its original attachment point (at the elbow for distal tears). Biceps tenodesis is a specific technique for proximal tears where the damaged long head tendon is cut and reattached to the humerus bone in a new location, lower in the shoulder. Tenodesis prevents the Popeye deformity and maintains better cosmetic appearance while sacrificing minimal function. Dr. Kumar discusses which approach is best based on tear location, patient age, activity level, and personal preferences.

Q7.Will I need physical therapy after biceps tendon repair?

Yes, physiotherapy is absolutely essential for successful recovery. It begins with passive range of motion exercises at 2 weeks, progresses to active movement at 6 weeks, and strengthening at 12 weeks. Most patients require supervised physiotherapy 2-3 times per week for 3-4 months, followed by a home exercise program. Skipping or inadequately performing therapy significantly increases the risk of stiffness, weakness, and poor functional outcomes. Arthoscenter provides comprehensive in-house physiotherapy with experienced therapists specializing in tendon repairs.

Q8.Can biceps tendon tears heal without surgery?

Proximal biceps tendon tears can heal without surgery, though the tendon typically does not reattach to its original location. Many older or less active patients do well with conservative treatment, accepting minor strength loss and cosmetic changes. However, distal biceps ruptures almost always require surgery for optimal functional recovery. Without surgery, distal tears result in permanent 30-40% loss of supination strength and noticeable weakness in daily activities requiring forearm rotation. Dr. Kumar provides honest guidance on when conservative treatment is appropriate versus when surgery is clearly beneficial.

Q9.When can I return to sports after biceps tendon repair?

Return to sports is gradual and sport-dependent. Light activities like walking and cycling can resume at 6-8 weeks. Golf and swimming typically allowed at 3-4 months with surgeon approval. Contact sports, weightlifting, and overhead throwing sports usually require 6-9 months for safe return. Full tendon healing takes 9-12 months. Returning too early risks re-rupture. Dr. Kumar provides sport-specific rehabilitation protocols and clearance based on strength testing to ensure safe return to competition.

Q10.How much does biceps tendon repair cost at Arthoscenter?

The cost varies based on surgical technique (arthroscopic vs. open), anesthesia type, and whether proximal or distal repair is performed. Distal repairs are typically more expensive due to longer operative time and specialized fixation devices. Contact Arthoscenter for detailed pricing information. Many insurance plans cover biceps tendon repair when medically necessary. We also offer flexible payment plans and work with cashless insurance providers. Dr. Kumar ensures patients understand all costs upfront with no hidden fees.

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