My husband is a construction worker with a good paying job and no other skills. So his job is vital to our family support. He has been off for three months now due to a torn biceps tendon. After surgery, he’s been in physical therapy to regain his strength needed for the job. The question I have is this — X-rays show he has some bone forming inside the muscle where they reattached the tendon to the bone. Will this add or subtract to his strength? I guess I’m worried that this will cause further problems.

Ruptures of the biceps tendon at the elbow can be very disabling and often require surgical repair or reconstruction. Studies over the last 30 years (since the mid-1980s) have given us enough data to see long-term results of both conservative (nonoperative) care and surgical management. And over those 30 years many improvements have been made in surgical techniques to reduce complications following surgery and to improve strength of the repair (referred to as tendon-to-bone fixation).

We know now that many patients heal with additional bone forming in the soft tissue. This effect called intrasubstance heterotopic bone or heterotopic ossification. This complication does not seem to adversely affect final outcomes. Patients appear to do just as well as those individuals who do not form the additional bone. Pain and function (motion and strength) are unaffected by the bone formation.

Whether or not the added bone increases actual strength has not been tested. Some patients observe increased stiffness but this is not consistent among all patients and may not be directly linked with the ossification. A rehab program that is designed to prepare your husband to return-to-work is likely the best way to ensure adequate strength, flexibility, and motion for the job tasks.