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Elbow Flexor Tendon Tear Repair

What is Elbow Flexor Tendon Tear Repair?

Elbow flexor tendon tear repair is a surgical procedure to restore function and strength to a torn flexor tendon in the elbow. The flexor tendons, particularly the biceps brachii tendon and the brachialis tendon, are responsible for bending (flexing) the elbow and assisting with forearm rotation. When these tendons are torn, either partially or completely, surgical repair may be necessary to regain full arm function.

Indications for Elbow Flexor Tendon Tear Repair

Elbow flexor tendon tear repair is indicated primarily for complete distal biceps tendon ruptures, especially in active individuals who require full strength for daily activities or work. Surgery is recommended when there is significant weakness in elbow flexion and forearm supination, which can impair function. It is particularly beneficial for athletes, manual laborers, and physically active individuals who rely on upper limb strength. Additionally, surgical intervention is considered when non-surgical management fails, leading to persistent pain or functional limitations. In cases of chronic tears with tendon retraction, early repair is preferred for improved surgical success, although delayed repairs may be considered in some cases with tendon grafting.

Procedure for Elbow Flexor Tendon Tear Repair

The surgical repair of an elbow flexor tendon tear, most commonly the distal biceps tendon, involves the following steps:

  • The patient is placed in a supine or lateral position, and general or regional anesthesia is administered.
  • A single or dual-incision approach is used to access the torn tendon near the elbow. The distal biceps tendon is identified, and any scar tissue is removed.
  • The retracted tendon is carefully mobilized, and its end is prepared for reattachment by trimming frayed edges.
  • If necessary, a tendon graft may be used for chronic cases with excessive retraction.
  • A tunnel or socket is created in the radial tuberosity (for biceps tendon) or the humerus (for brachialis tendon).
  • The tendon is anchored to the bone using suture anchors, cortical buttons, or interference screws.
  • The wound is closed with sutures, and the arm is placed in a brace or splint to protect the repair.

Postoperative Care and Recovery

Postoperative care for elbow flexor tendon tear repair involves immobilization in a splint or brace for 1-2 weeks to protect the repair, followed by gradual rehabilitation. Early range-of-motion exercises begin after immobilization to prevent stiffness, while strengthening exercises are introduced around 6-8 weeks. Patients typically regain functional use of the arm within 3-4 months, but full recovery, including return to heavy lifting or sports, may take 4-6 months. Physical therapy focuses on restoring flexion, supination, and grip strength while avoiding excessive strain on the healing tendon. Compliance with rehabilitation protocols is crucial to prevent complications such as stiffness, re-rupture, or loss of strength.

Risks and Complications

While elbow flexor tendon tear repair is generally successful, like any surgical procedure, it carries certain risks and potential complications. These include:

  • Infection
  • Nerve injury
  • Stiffness and loss of motion
  • Chronic pain or weakness
  • Tendon re-rupture or failure
  • Blood clots or deep vein thrombosis (DVT)
  • Heterotopic ossification – Abnormal formation of bone tissue around the tendon or joint

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