News broke earlier this afternoon that Matt Elam will have to undergo season-ending surgery to repair a complete tear of his biceps brachii. In this article we'll take a closer look at his injury and what his rehabilitation will entail in the months to come.
The biceps brachii is a two-headed muscle and crosses both the shoulder and elbow joints. The proximal tendons of the short head and long head originate at different points on the scapula (shoulder blade) and their muscle bellies unite to form the distal biceps tendon which inserts onto the radius bone of the forearm. The biceps is responsible for elbow flexion (bending), forearm supination (turning palm up), and also plays a role in shoulder flexion (raising arm).
The majority of biceps tears occur at the proximal biceps tendon and typically involve only the long head. This is due to the fact that the tendon of the long head runs directly over the shoulder joint, thus placing it in a more vulnerable position. The tendon of the short head is hardly ever compromised. Therefore, even in situations where an individual has a complete tear of the long head, the short head is able to compensate and the person is able to maintain functional use of their biceps without requiring surgery.
A complete tear of the distal biceps tendon can be much more problematic and appears to be what Elam is currently dealing with. The rupture results in the tendon being detached from the radius and the muscle pulls up towards the shoulder (like window blinds). This creates an abnormal shape of the biceps along with a significant loss of strength and range of motion. Surgery is necessary at this point in order to restore normal function of the upper extremity.
Surgeons utilize several different procedures to re-attach the distal biceps tendon to the radius. It essentially comes down to their preference and experience. Some prefer to use two incisions, while others use only one incision. Some choose to drill holes in the bone and attach the tendon via sutures while others utilize small metal implants. There is ultimately no method that has proven to be superior to another and the odds of re-rupturing the tendon are extremely low for each.
During the first week after surgery Elam will have to wear an immobilizing splint at all times before being placed in a hinged elbow brace. Early emphasis is placed on minimizing swelling and performing light elbow passive range of motion (ROM) exercises.
In weeks 3 to 6 following surgery, rehab will consist of further elbow ROM exercise (passive and active), grip strengthening, and light elbow strengthening. After 6 weeks patients can typically stop wearing their brace and the goal is to have full elbow and forearm ROM.
After the 6 week mark the goal of rehab is to continue to improve overall stability and strength of the elbow, shoulder, and scapular muscles. The patient's exercise regimen should be regularly altered and progressed so that a full recovery is achieved by 4-6 months.
- Bobby Esbrandt, PT, DPT, PES