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Distal Biceps Repair

Overview

Distal Biceps Ruptures

A Distal Biceps Rupture is when a tear forms in the tendon connecting the bicep muscle to the radius bone. The result is pain, and a pronounced difficulty flexing and rotating the arm from a palms-down, to a palm-up position. This movement is known as supination.

Your Arm Biceps are: The large muscles in the upper arm that enable you to bend your elbow and rotate your forearm.

 

The Facts on Distal Biceps Ruptures:
  • Injury and overuse are the most common causes of a bicep rupture.
  • Men between the age of 40 and 60 are at the highest risk.
  • Often a “pop” sound is heard from the elbow at the time of injury.
  • Once the bicep tendon is torn, it does not grow back and reattach to the bone.
Symptoms

Distal Biceps Repair

Patients with a distal biceps rupture often report:

  • An unexpected, eccentric extension force applied to the flexed elbow
  • Bruising
  • A bulge in the upper arm
  • A “pop” sound at the elbow
  • A noticeable weakness when flexing the impacted arm
  • Pain when arm is at a 90 degree angle with the palm facing upward

Evaluation by Team Ahmad

Dr. Ahmad and his team of health professionals will greet you and start your visit with a discussion of your symptoms, sport, level of competition, desired activity level and mechanism of injury. Next, the doctor will exam your biceps, focusing on:

  • Evidence of bruising (ecchymosis)
  • Evidence of tenderness, especially surrounding the biceps muscle and tendon
  • Whether or not the distal biceps tendon can be felt or not
  • Whether or not proximal muscle retraction is seen in the upper arm
  • Weakness when arm is flexed

Dr. Ahmad may request an MRI to confirm the rupture or any degeneration.

Treatment Options

Non-surgical

A nonsurgical approach is usually considered for:

  • Elderly patients
  • Sedentary patients
  • Patients who wish to avoid surgery
  • Patients who are too ill to undergo surgery

Surgical

Anatomic repair is recommended for patients with a confirmed distal biceps tendon rupture—especially when a patient’s partial tears fail to respond to nonsurgical treatment. Dr. Ahmad’s technique is considered the strongest technique and allows for the most rapid healing and return to activity.

During surgery, Dr. Ahmad will:

  • Remove unhealthy parts of the tendon
  • Reattach the tendon to the bone (radial tuberosity) using a metal button

Radial Tuberosity

Dr. Ahmad performed 2 different surgeries on my daughter at 2 different times. She had excellent outcomes both times. She is a high level gymnast and needed to be seen by the best. Dr. Ahmad is the best.

Mary Louise Lea

Dr Ahmad is extremely knowledgeable and professional! I highly recommend him and his staff. They were very supportive throughout my son’s recovery from UCL surgery!

Anonymous

Dr Ahmad came into each appointment up to date on my file, ready to discuss how treatment was progressing and fully engaged on my rehabilitation. He listened attentively to my feedback and was efficient without being rushed. Thanks to his medical care, I’m in better shape than I was before injury.

Anonymous

Dr. Ahmad’s Experience

Dr. Ahmad is nationally recognized expert in distal biceps tendon repair surgery and has designed and studied the optimal methods to surgical repair techniques. His undergraduate training in mechanical engineering has allowed him to research the optimal methods of treatment. Dr. Ahmad has performed several hundred elbow surgeries and has treated all types of patients from elite power lifters to recreational athletes who sustained biceps tendon tears.

Listed below is Dr. Ahmad’s scholarly articles and research published to help distal biceps tendon tear treatment.

Peer Reviewed Scientific Journal Articles
  1. Gancarczyk SM, Makhni EC, Lombardi JM, Popkin CA, Ahmad CS. Arthroscopic Articular Reconstruction of Capitellar Osteochondral Defects. Am J Sports Med. 2015 Oct;43(10):2452-8. doi: 10.1177/0363546515594448. Epub 2015 Aug 13.
  2. Iyengar JJ, Grantham, Byrum, Ahmad CS: The Curveball as a Risk Factor for Injury: A Systematic Review, Sports Health, Sports Health. 2015 Jan;7(1):19-26.
  3. Redler LH, Watling JP, Ahmad CS: Physical Examination of the Throwing Athlete’s Elbow. American Journal of Orthopedics 2015 Jan;44(1):13-8.
  4. Makhni EC, Morrow ZS, Luchetti TJ, Mishra-Kalyani PS, Gualtieri AP, Lee RW, Ahmad CS: Arm Pain in Youth Baseball Players: A Survey of Healthy Players. Am J Sports Med. 2015 Jan; 43(1) 41-6.
Review Articles, Current Concept Articles and Surgical Techniques
  1. Churchill RW, Munoz J, Ahmad CS, Osteochondritis dissecans of the elbow. Current Reviews in Musculoskeletal Medicine, 2016 Apr 28.
  2. Makhni E, Jegede KA, Ahmad CS: Pediatric Elbow Injuries in the Athlete, Sports Medicine and Arthroscopy Review on Athletic: Elbow Injuries and Their Treatment, Editor Marc Safran, 22:16-24, 2014
  3. Byram IR, Kim HM, Levine WN, Ahmad CS: Elbow Arthroscopic Surgery Update for Sports Medicine Conditions, Am J Sports Med, 41:2191-202, 2013
  4. Byram IR, Shillingford JN, Fink LA, Ramirez JM, Ahmad CSLesser Tuberosity Osteotomy With Cerclage Wire Repair for Total Shoulder Arthroplasty: Surgical Technique , Techniques in Shoulder & Elbow Surgery. 13:151-156, 2012
  5. Hsu SH, Moen TC, Levine WN, Ahmad CS: Physical Exam of the Athlete’s Elbow. American Journal of Sports Medicine, 40(3) 699-708, 2012
  6. Greiwe MRSaifi CS, Ahmad CS: Pediatric Sports Elbow Injuries, Clinics in Sports Medicine, 29:677-703, 2010
  7. Ahmad CS, ElAttrache NS: Treatment of Elbow Capitellar Osteochondritis Dissecans. Techniques in Shoulder and Elbow Surgery, 7:169-174, 2006
  8. Alcid J, Ahmad CS, Lee TQ: Elbow Anatomy and Structural Biomechanics. Clinics in Sports Medicine,23:503-517, 2004
Textbooks / Guest Editorship
  1. Ahmad CS, Editor: Sports Medicine 2. Instructional Course Lectures Sports Medicine Specialty Volume 2: American Academy of Orthopaedic Surgeons, Illinois, 2011
  2. Ahmad CS, Editor: American Academy of Orthopaedic Surgeons Monograph Series. Pediatric and Adolescent Sports Injuries. American Academy of Orthopaedic Surgeons. American Academy of Orthopaedic Surgeons, Rosemont. Series 43, pp 1-199, 2010
  3. Ahmad CS, Levine WN, Co-Editors: Current Concepts in Elbow Surgery Part-1 Soft Tissue/Sports. Operative Techniques in Orthopaedics. Elsevier, Illinois. Vol 19, 189-264, 2009
  4. Levine WN, Blaine TA, and Ahmad CS, Editors: Minimally Invasive Shoulder and Elbow Surgery. Informa Publishers, New York. 2007
Book Chapters
  1. Ahmad CS, Gonzalez-Lomas: “Elbow Injuries in the Athlete” AAOS Comprehensive Orthopaedic Review 2cd edition, edited by Martin Boyer, MD Keener editor of the Shoulder and Elbow section, 2014
  2. Vitale MA, Ahmad CS: Elbow Arthroscopy: Setup, Portal Placement and Simple Procedures: Instructional Course Lectures Volume 60: Egol, Editor: American Academy of Orthopaedic Surgeons, Illinois, 60:171-180, 2011
  3. Ahmad CS, Vitale MA, ElAttrache NS: Elbow Arthroscopy: Capitellar Osteochondritis Dissecans and Radiocapitellar Plica: Instructional Course Lectures Volume 60: Egol, Editor: American Academy of Orthopaedic Surgeons, Illinois, 60:181-190, 2011
  4. Gonzalez-Lomas, G, Ahmad CS, Wanich T, ElAttrache NS: Osteochondritis Dissecans of the Elbow: Diagnosis, Operative and Non-Operative Management, Including Grafting: Indications and Techniques: AANA Advanced Arthroscopy: The Wrist and Elbow, Field & Savoie III, Editors: Elsevier, Elsevier, 2010
  5. Vadasdi KB, Perez V, Ahmad, CS: Adolescent Throwing Injuries, American Academy of Orthopaedic Surgeons Monograph Series. Management of Common Sports Injuries in Pediatric and Adolescent Patients: Ahmad CS, Editor: American Academy of Orthopaedic Surgeons, Illinois, 2010
  6. Ahmad CS: Elbow Injuries in the Athlete, American Academy of Orthopaedic Surgeons. Comprehensive Orthopaedic Review: Lieberman, Editor: American Academy of Orthopaedic Surgeons, Illinois, 2009
  7. ElAttrache NE, Wei AS, Lomas G, Ahmad CS: Elbow Arthroscopy, Biologic Joint Reconstruction: An Alternative to Joint Arthroplasty: Cole, Gomoll, Editors: SLACK Incorporated, New Jersey, 2009
  8. Ahmad CS, Lomas G: Pediatric and Adolescent Sports Elbow Injuries, American Academy of Orthopaedic Surgeons Monograph Series. The Athletes’ Elbow-Current Concepts: Levine WN, Editor:American Academy of Orthopaedic Surgeons, Illinois, 2008
  9. Ahmad CS: Athletic Injuries and the Throwing Athlete: Elbow, Orthopaedic Knowledge Update: Shoulder and Elbow 3: Galatz LM, Editor: American Academy of Orthopaedic Surgeons , Chicago, 2008
  10. Ahmad CS, ElAttrache NS: Mosaicplasty for Capitellar Osteochondritis Dissecans, Advanced Reconstruction of the Elbow: Yamaguchi K, King GJW, McKee, O’Driscoll SWM, Editors: American Academy of Orthopaedic Surgeons , Chicago, 2007
Moderator for Scientific Sessions and Instructional Courses

AOSSM

  1. AOSSM Annual Meeting, Moderator, The Adolescent Elbow: A Rapid Fire Case-Based Discussion, Colorado Springs, CO, July 2016
  2. AOSSM Annual Meeting, IC 402, The Baseball Thrower: What Can Non-Surgeons Teach Us?, Michael T. Freehill MD, Thomas F. Walter, Jeff Strahm ATC, Matt Hobbs, Kevin E. Wilk PT, DPT, Christopher S. Ahmad MD, Colorado Springs, CO, July 2016.
  3. AOSSM Annual Meeting, Moderator, Throwing Elbow, Orlando, FL, July 2015.
  4. AOSSM Annual Meeting, Elbow Injuries in Throwing Athletes IC 204, Instructional Course, Christopher S. Ahmad MD (New York, NY); Jeffrey R. Dugas MD (Birmingham, AL); Michael G. Ciccotti MD (Philadelphia, PA), Buddy Savoie, MD, Seattle, WA, July 2014
  5. AOSSM Annual Meeting, Elbow Injuries in Throwing Athletes IC 204, Instructional Course, Christopher S. Ahmad MD (New York, NY); Jeffrey R. Dugas MD (Birmingham, AL); Michael G. Ciccotti MD (Philadelphia, PA); George A. Paletta Jr, MD (Chesterfield, MO), Buddy Savoie, MD, Chicago, IL, July 2013
  6. AOSSM Annual Meeting, Scientific Session: Elbow: Moderator. Chicago, IL July 2013
  7. AOSSM Specialty Day Annual Meeting, Scientific Session 3: Elbow, Moderator. San Francisco, CA, February 2012

Orthopaedics Today Conferences (Moderator)

  1. Orthopedics Today Symposium, Moderator, Sports Elbow Conditions, Lahaina, HI, January 2017
  2. Orthopedics Today Symposium, Moderator, Sports Elbow Conditions, Waikoloa, HI, January 2016
  3. Orthopaedics Today Symposium, Sports Elbow, Moderator, Koloa, Hawaii, January 2015.
  4. Orthopaedics Today Symposium, Elbow Update, Moderator. The Fairmont Orchid. Kohala Coast, Hawaii. January 2009

Distinguished Speaker/Guest Professor

  1. 20th Annual Robert K. Kerlan, M.D. Memorial Lecture, Distinguished Lecturer, Adolescent Throwing Injuries, October 13-14, 2016, Los Angeles, CA.
Multimedia
  1. AAOS/POSNA Webinar: Elbow Injuries in the Adolescent Throwing Athlete, “UCL Injuries in Adolescent Pitchers,” June 2016.
  2. Ahmad CS: “Arthroscopic Treatment of Osteochondritis Dissecans”. Elbow Arthroscopy DVD, AAOS/AANA, Larry Field and Scott Steinmann co-editors, 2014
  3. Ahmad CS, ElAttrache NS: Elbow Arthroscopy: Beginners to Advanced, American Academy of Orthopaedic Surgeons, 2009
  4. Ahmad CS, ElAttrache NS: Athletic Injuries about the Elbow, Orthopaedic Knowledge Online, American Academy of Orthopaedic Surgeons, 2004
National Research Podium Presentations Presented
  1. Ahmad CS, O’Driscoll SW, ElAttrache NS: Elbow Arthroscopy: Beginners to Advanced. American Academy of Orthopaedic Surgeons, San Diego, CA, February 2011
  2. Ahmad CS, Conway J, O’Driscoll S, ElAttrache N: Elbow Arthroscopy: Beginners to Advanced. American Academy of Orthopaedic Surgeons, New Orleans, LO, March 2010
  3. Conway JE, Ahmad CS: The Throwing Athlete. American Academy of Orthopaedic Surgeons-Specialty Day, Las Vegas NV, February 2009
Scientific Exhibit Presentations
  • Mlynarek R, Weber A, Nepple J, Dines J, Li X, Ahmad CS, Bedin, A Scientific Exhibit #29: Approach to Diagnosis and Treatment of Shoulder and Elbow Pain in the Skeletally Immature Athlete, American Academy of Orthopaedic Surgeons Annual Meeting, Orlando, March 2016
Invited Instructional Course and Symposium Presentations
  1. O’Donnell E, Vitale M, Ahmad CS, authors, Paper Presentation: A National and Statewide Analysis of Elbow Arthroscopy, American Academy of Orthopaedic Surgeons Annual Meeting, Orlando, March 2016
  2. AAOS ICL 130, Elbow Arthritis in the Young Athlete, Elbow Injuries Surgical Management, American Academy of Orthopaedic Surgeons, Orlando, FL March 2016
  3. AAOS ICL 127, Savoie F, Ramsey M, Romeo A, Ahmad CS: Elbow Arthroscopy: Beginners to Advanced- Throwing Elbow Injuries. Throwing Elbow Injuries, American Academy of Orthopaedic Surgeons, New Orleans, LA, March 2014
  4. AAOS ICL 368, Savoie F, Ramsey M, Romeo A, Ahmad CS: Elbow Arthroscopy: Beginners to Advanced- Throwing Elbow Injuries. Throwing Elbow Injuries, American Academy of Orthopaedic Surgeons, Chicago, IL, March 2013
  5. AAOS ICL Savoie F, Ramsey M, Romeo A, Ahmad CS: Elbow Arthroscopy: Beginners to Advanced- Throwing Elbow Injuries, American Academy of Orthopaedic Surgeons, San Francisco, CA, February 2012
  6. 2011 AAOS Top Controversies, Speaker, Elbow Arthroscopy: “How To” Beginners Guide and Shoulder I Transition from Open Capsular Releases and Tennis Elbow Releases to an All-Arthroscopic Technique, New York, NY, October, 2011

AOSSM

  1. Ahmad CS: Elbow, AOSSM & AAOS Sports Medicine Review Course for Subspecialty Certification and Maintenance of Certification, Chicago, August 8, 2014
  2. Ahmad CS: Elbow, AOSSM & AAOS Sports Medicine Review Course for Subspecialty Certification and Maintenance of Certification, Chicago, August 9, 2013
  3. AOSSM Annual Meeting, Faculty, IC: Overview of the Athlete’s Elbow. Providence, RI. July 2010
  4. Arthrex Elbow Arthroscopy Series, Basic Elbow Arthroscopy. Scottsdale AZ, July 2004

Orthopedics Today Symposia

  1. Orthopedics Today Symposium, Faculty, Surgical Spotlight: Elbow Arthroscopy Basics and Treatment of Capitellar OCD, Waikoloa, HI, January 2016
  2. Orthopedics Today Symposium, Faculty, Panel Discussion: Getting Control of High School Baseball Elbow Injuries, Waikoloa, HI, January 2016
  3. Orthopedics Today Symposium, Faculty, High School Baseball Elbow Injuries, Koala, HI, January 2015
Invited Grand Rounds and Guest Lectureships
  1. Roosevelt Hospital Grand Rounds, Speaker, Elbow Throwing Injuries, New York, NY, December 20, 2011
  2. Detroit Metropolitan Course, Faculty, Adolescent Shoulder and Elbow Sports Medicine Injuries (Clinical), January 27, 2010
  3. Danbury Hospital Grand Rounds, The Throwing Athlete. Danbury CT, April 2009

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