This surgery is performed as a day case operation under general anaesthetic. A 3cm incision is made over the upper end of your forearm. Your biceps tuberosity of the radius, where the tendon pulled off from, is carefully exposed and your avulsed tendon is retrieved from your arm. It is then reinserted into a small bone socket that is drilled in your radius bone at the tuberosity. The tendon is fixed using sutures tied to a titanium button that is flipped on the far side of the radius to hold the tendon in its socket. A PEEK (special surgical plastic) interference screw is usually inserted as an extra security. The wound is thoroughly washed out, infiltrated with local anaesthetic and closed.
Sometimes, if your torn tendon has retracted a long way up your arm, a second incision is needed to fetch teh tendon and bring it down to the radius.
These images show Intra-operative x-rays of the deployed biceps button with the tendon docked in the radial tuberosity
An video animation of the procedure can be found by copying the following link into your browser: https://www.arthrex.com/resources/animation/PCEPsiN8_0CRawFAWSQicg/distal-bicepsbutton-tension-slide-technique
Ideally you should have your distal biceps rupture repaired within two weeks. This is because a longer delay increases the muscle and tendon retraction and allows dense scarring to from around the ruptured tendon. In cases of delay it is therefore sometimes impossible to bring the tendon back down to the radius. In this case a graft needs to be used to bridge the gap (this can be either a hamstring tendon from your leg, or a donor 'allograft' tendon). Repairs of chronic tears (more than a few weeks old) also carry more risk of injury to nerves and vessels so a longer curved incision is required to provide safe visualisation of the structures.
You will wake up in a sling and a bulky bandage will cover your wound. You will go home the same day. You may remove your bulky dressing at 3 days, but keep your sticky dressing clean and dry for two weeks. You will be seen in two weeks and any sutures will need to be trimmed at that point.
You can begin gentle active elbow range of motion exercises without any resistance immediately. A good way to do this is by lying on your back and holding your arm up to the ceiling. Then allow gravity to bend your elbow, before slowly straightening it. You may feel tight in extension for a while – do not push this, but let it improve gradually as your muscle adapts to re-tensioning. Please avoid any heavy load or forceful activities until 3 months after surgery. At that point you can then begin to build up resistance and can do anything you like from 6 months.
If you have had a graft-reconstruction of a chronic tear, your recovery will be slower as the tissues will take longer to strengthen.
This is generally a safe operation and patients do very well, but there are some complications specific to repair of the distal biceps you should be aware of:
Infection: this is rare (1-3%)
New bone formation (heterotopic ossification): This may sometimes be visible on x-ray, but only very occasionally will this new bone causes pressure on other structures or limit movement. Thorough washout of any bony debris created during surgery helps reduce the risk.
Re-rupture: this is rare (2%) with modern techniques of fixation and compliance with the rehabilitation protocol. If the tendon does not heal and you remain symptomatic, revision surgery may be indicated.
Making the right choice about the best treatment for you means getting the right information. During your consultation, please do feel free to ask Mr Granville-Chapman to explain anything that you do not fully understand, and for his advice about the pros and cons of any treatment.
Mr Granville-Chapman was very polite and his examination and explanation of my symptoms and expected treatment was thorough
I found Mr Granville-Chapman to be very knowledgeable and professional. He put me very much at ease and explained all the options that I have thoroughly. He also told me to look for further information on the condition and procedures that I needed on his website, which gave lots of information and detail. It was also easy to understand for those without a medical background. I would highly recommend his services to anyone that has shoulder problems and requires a solution.
I attended for a repair of my right bicep tendon. After a thorough examination, Mr Granville-Chapman arranged an operation to be undertaken within 2 days which was extremely quick; he explained his reasoning which was both thorough and reassuring, explaining both the options of undergoing surgery and deciding to undertake conservative management.On the day of the surgery Mr Granville-Chapman was again very reassuring as although this is minor surgery I was still somewhat apprehensive. He came to fully explain the procedure and afterI woke up was quick to check on how I was doing.Overall I am very happy with the careMr Granville-Chapman
I have been very pleased with my treatment so far. Mr Granville-Chapman combines brisk efficiency with a pleasant, sympathetic manner. My operation, however, is still to come ...
From the initial consultation, through surgery on a fractured wrist, and now post-operative follow up, it has been a very positive and reassuring experience with Mr Granville-Chapman. I would have no hesitation in recommending him to someone else.
A first class clinician. A skilled surgeon with an excellent bedside manner.
A very pleasant Consultant who knows exactly how to make pain go away.
Mr Granville - Chapman has an excellent bedside manner. He engaged with my 12 year old son at an appropriate level and took the time to ensure that he understood the procedure and answer all his questions. He is thoroughly professional and I would not hesitate to recommend him.
I have been very pleased with the attention I have received. Mr. Granville-Chapman has reassured me that my symptoms are normal. It is very easy to make appointments that suit me.
Mr Granville chapman I found be caring informative and professional I would recommend him to all if you have a problem don't hesitate to contact him you won't be disappointed.
I recently broke my right clavicle in a mountain bike accident and it was repaired by Mr Granville-Chapman by adding a plate on top of the bone. Having just finished the last post-op consultation, I can confirm that I have been very happy with the process all along. In particular, Jeremy took time to explain in detail why a plate was needed, what the procedure would entail, and also was very patient answering my questions comprehensively beforehand and after during the recovery phase. Would certainly trust this competent surgeon to fix any future fractures I might sustain.
Mr Granville-Chapman has looked after my 15 year old son brilliantly, explaining the surgery, recovery and best way forward, and Kate has been very supportive helping with logistics etc, thank you so much.
So far my experience with Mr Jeremy Granville-Chapman has been personal and informative with regard to the operation I will be having. I feel confident that my operation will be a success and for this reason I am very happy to have Mr Jeremy Granville-Chapman as my consultant.
Very knowledgeable and helpful. Takes the time to make sure you're getting the treatment you need.
Mr Jeremy Granville -Chapman is not only a highly skilled consultant but is able to put you straight away at ease .My appointments were arranged very swiftly which was great, when you are experiencing severe pain. I am very happy with my treatment so far . many thanks to everyone who was involved in my treatment.
Polite, helpful, professional. Makes an effort to ensure full understanding of issues and procedures to be done. Highly satisfied
Very pleasant. Clear, careful explanations & options/possibilities. I feel well informed, and happy that my concerns are being well addressed, with a plan of review of the symptoms.
Excellent advise with everything explained clearly and a successful treatment which has benefited be greatly.
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