What does the operation involve?
A distal biceps repair is an operation to treat a torn biceps tendon at the elbow. It is usually performed under a general anaesthetic as a daycase procedure, with most people going home within hours of their surgery.
The procedure is performed through a cut over the front of the elbow. Through this incision, Mr. Davies carefully frees up the torn tendon, taking care not to damage the nearby nerves. He then makes a small hole in the bone where the biceps tore from and reattaches the end of the tendon securely using a small metal plate attached to some very strong sutures. The skin is usually stitched using dissolving stitches that don’t need to be removed. A light dressing and bandage are applied and you are provided with a sling.
What are the specific risks and benefits of this operation?
The main benefit of this surgery is to repair the torn biceps tendon. As with any surgery, there are risks as well as benefits. The most frequent risks are:
- Infection: Around 1 in 100 people develop an infection in the skin where the cut was made. Infections will cause redness, increasing pain and sometimes some wound leakage around 1-2 weeks after surgery. It is important that you see your doctor if you think that this has happened. If you do have an infection, it usually settles with a course of antibiotics taken by mouth, but occasionally you may need surgery to wash the infection out of the wound.
- Problems with the scar: Some people develop a scar which is sensitive to touch or raised above the surrounding skin. Most scars take 3-6 months to settle and usually this problem gets better if you regularly massage your healed scar with moisturiser.
- Re-rupture: After the tendon has been repaired, it needs to heal back to the bone. Since the tendon has been damaged and tore once, there is always the possibility that it does not heal and could tear again. It is important to follow your physiotherapist’s advice and avoid excessively strenuous activity for a few weeks after surgery to allow the tendon to heal.
- Fracture: Since a small hole is drilled in the bone to reattach the tendon, there is a risk that the bone will fracture because the hole will very slightly weaken the bone. If this happens, it may require further surgery to fix the fracture.
- Nerve injury: Mr. Davies takes great care to protect the important nerves around your elbow during this operation. Two nerves in particular are at risk: One supplies feeling to the outside of your forearm and sometimes back of your hand. If this nerve is damaged, you can have a loss of skin sensation in this area. Another nerve that is close by is responsible for straightening the fingers and the wrist. If this is damaged, you may have weakness or paralysis of these movements. The chance of this sort of nerve damage is around 1 in 100. If this were to happen, it may be temporary of permanent. If it is permanent, further treatment may be offered to restore the strength and movement to your hand and wrist.
- Risks of Anaesthetic: Before your operation, you will have your preop health checkup. Serious problems related to the anaesthetic are very rare (less than 1 in 10,000 for healthy people), but can be serious and sometimes life-threatening. These problems may include heart attack or a stroke, which can affect the movement of any part of your body, speech problems or even blindness. With any surgery, there is also a risk of a blood clot in your leg (DVT / deep vein thrombosis) or lung (PE / pulmonary embolism) and some people are given blood-thinning medications if their risk is higher. Your anaesthetist and surgeon can discuss your own personal risks and the measures they take to keep you as safe as possible throughout surgery.
What is the recovery after this surgery?
You will be provided with a sling for comfort, along with instructions from the physiotherapist about how to put on and take off the sling. There is no need to wear the sling for more than 1-2 days, but you might find it helpful to wear it occasionally if your elbow becomes painful. Most people have little or no pain immediately after surgery due to the local anaesthetic put into the wound. It is vitally important that you start taking painkillers supplied to you before the local anaesthetic wears off. Some people also find an ice pack helpful in the first few days. It is advisable to get on your feet and walk around frequently to reduce the risk of blood clots in your legs.
Your physiotherapist will give you some exercises to start. It is important that you do these exercises to prevent your elbow from becoming stiff and maximise your chance of a good recovery. Don’t overdo it though as you need to give your tendon a chance to heal. You will usually be seen in clinic 2-4 weeks after surgery to check that everything is OK. You will notice your elbow improving over the next few weeks, but it can take several months of work with your physiotherapist to get the full benefit of surgery.
Returning to Normal Activities
You can do light activities as you feel comfortable. It is advisable to avoid heavy lifting and repetitive work for 6 weeks after surgery to allow the tendon to heal.
When can I drive?
Most people can return to driving after around 2 weeks or when they feel comfortable.
When can I return to work?
This depends on how heavy your work is. If you work at a desk, this can be as soon as you feel comfortable. For heavier jobs, it will take longer. The key is to listen to your body, don’t overdo it, and build up to normal activities slowly.
When can I return to sport?
Some sports put more strain on your elbow than others. Most people return to light exercise in 4-6 weeks and can then slowly build up to normal activity from there. The key is to listen to your body, don’t overdo it, and build up to normal activities slowly.