The Elbow is crossed by several tendons that help bend it and straighten it, and is the origin of several muscle groups that move the forearm, wrist, and fingers. It is also supported by two main groups of ligaments to help keep the joint together as it goes from a fully straight position to a fully bent one.
The two major tendons that cross the elbow are the Biceps tendon and the Triceps tendon. The two major ligament groups are the lateral collateral ligament and the ulnar collateral ligament.
Biceps Tendon Tears
The Biceps tendon crossed in front of the elbow and its job is to bend it as well as turn your forearm outwards (supination) as when you turn the ignition key of a car. Biceps tendon tears are usually sudden and unexpected, and may happen with forceful pull against resistance, such as when lifting a heavy object. Prior to the injury, the elbow is most commonly pain and symptom free. Once it happens, the patient feels a pop, and may develop a sudden ‘pop-eye’ bulge to his arm.
Treatment depends mostly on the patients level of activity. For senior patients with limited demands and for those are willing to accept an obvious bulge, and do not care much about losing some strength after the injury has settled down, non-operative treatment may be adequate. The key point is to make that determination soon after the injury, as repairing the tendon becomes much more difficult after 3-4 weeks. (scroll down for a real story)
For the more active patients, especially when strength is important, repairing the tendon may be the better choice. It is preferred to do it soon after the injury, because the ruptured end tends to pull back, and once is starts to scar down, becomes harder to be pulled to length and reattached. Surgery involves reaching the tip of the tendon, reinforcing it with heavy sutures, and then My favorite technique is to attach a metal button to the tendon, which I then pass through a bone tunnel where the tendon had ruptures. I then flip the button on the back side of the bone to hold the tendon securely in the tunnel until it has healed. Usually the repair is very secure, and recovery takes a few weeks. It is important to remember that although the suture-button construct is very strong, it is designed only to secure the repair until it is healed. Returning to earlier level of function, before the tendon has healed, may risk rupturing it and early failure of the repair.
Real Story- I have a friend, a surgeon, who had this injury. After discussing the treatment options, he decided not to repair it. He has been pleased with his function and did not appreciate any loss in his strength or function. He did, however, find an advantage to his bulge- he shows it to his grand-kids and impresses them with his ‘big muscle’. He has one catch, though- he can only show them his right arm…
Triceps Tendon tears
The Triceps tendon is on the back side of the elbow. It helps straighten the elbow. When your arm is by your side, you may take it for granted that the elbow is ‘naturally’ straight, and that you put an effort to bend it. This is not true. Had you not had a triceps muscle, you will be slapping yourself in the face every time you reach above your head because the triceps works on keeping your elbow straight as you raise your arm.
Triceps Tendon tears are much less common than biceps tendon. They are also often missed. Tears may be sudden and complete, sometimes felt like a snap or like something has hit the elbow from the back. They may also be partial, and often dismissed as bursitis. The patients will notice it when it becomes hard to keep the elbow straight above the head and when trying to reach a shelf. The patient will also notice weakness pushing objects. When the tear is complete, surgery is often performed to restore strength. The rupture usually occurs at the bone, and surgery requires re-attaching the tendon back to the bone.
Collateral Ligament Tears