Two years ago, I tore my biceps tendon on a construction job. I switched jobs instead of having surgery to repair it. Now I find the pain and loss of strength are making my new job difficult. Is it too late to have the surgery done?

Rupture of the biceps tendon can be a very disabling injury. Loss of motion and decreased strength can affect function. Pain along the inside of the elbow can hamper daily activities. It’s not a common injury, but one that is seen most often in middle-aged men. The mechanism of injury is usually a violent, eccentric contraction.

An eccentric contraction occurs when an already fully contracted muscle starts to lengthen. With a biceps tendon rupture, this means the biceps tendon was contracted putting the elbow in a position of flexion. Then as the elbow extended, the biceps lengthened. Sudden extension, especially with a weight in the hand can result in this type of biceps rupture.

This type of injury usually requires surgery right away. The surgeon finds the retracted tendon, pulls it back down, and reattaches it to the radial tuberosity. The radial tuberosity is the bony bump on the radius bone of the forearm where it meets the humerus (upper arm bone) to form the elbow. That’s the site of the original distal biceps insertion.

This procedure is considered an anatomical repair because it restores the tendon to its original site. If the surgery is delayed for a long period of time (18 months or more), then an anatomical repair may not be possible. The tendon retracts too far and then gets bound down in scar tissue.

In chronic cases of this type, the surgeon performs reconstructive surgery. A graft is used to make up the distance between the stump (end) of the retracted tendon and the elbow where it is reattached. The surgeon carefully removes scar tissue from around the tendon and nerve in the forearm, and then gently stretches the tendon as far as it will go before attaching the graft. The graft comes from the hamstring or Achilles tendon. It can be an autograft (taken from your own body) or an allograft (someone else’s tissue from a donor bank).

Results can be very satisfactory. Your first step is to have an orthopedic surgeon examine you and determine the best plan of care. There are different surgical techniques used for this type of reconstruction. Each case is decided on an individual basis. The surgeon will take into consideration your age, goals for the surgery, type of injury, and your current level of disability. He or she will be able to advise you according to the results of the evaluation.