Partial tear of distal biceps tendon

A couple months ago I injured my distal biceps tendon (pulling down rope with a lot of drag on a top rope belay…what an annoying way to get hurt). I’ve tried a bunch of rehab and it hasn’t improved, so I finally went to a doctor and his recommendation was that for a high utilization activity like climbing I should get surgery. I have an mri and appointment with a surgeon so a few weeks before I need to make a call, but I wanted to hear others’ experiences. I’m still able to climb at the hardest level I’ve done, but I also have pain when doing anything with the bicep, including just holding a coffee cup  

I found another thread on here about complete tears, but would be curious to hear from anyone with a partial tear what you did and how it worked out. 

Interesting. I haven't had an MRI, mainly because I just spent a lot of money on an MRI for me knee, but for the past year I have had the coffe cup pain. I injured the bicep in December of last year. I keep waiting for it to heal, but it doesn't. Physical Therapy did nothing for it. 

No advice for you, but I'm curious what you find out.

Tom Woodswrote:

Interesting. I haven't had an MRI, mainly because I just spent a lot of money on an MRI for me knee, but for the past year I have had the coffe cup pain. I injured the bicep in December of last year. I keep waiting for it to heal, but it doesn't. Physical Therapy did nothing for it. 

No advice for you, but I'm curious what you find out.

Yeah sounds similar. I’ll let you know what I hear and where I net out. 

Josh Swrote:

Yeah sounds similar. I’ll let you know what I hear and where I net out. 

Digging this one up,  for my own benefit I'd love to know what was found out

Boreal Strutwrote:

Digging this one up,  for my own benefit I'd love to know what was found out

The MRI said the tear was 50% thickness and the surgeon's take was that this was right on the margin — more than 50% and he'd recommend surgery. I ended up doing one last bout of rehab, this time with Matt Heyliger ( sendagain.co/) who is *by far* the most knowledgable PT I've ever worked with. Over the course of 3-6 months I was able to rehab it completely, so at around the one year mark I had no residual pain. These days (a bit over two years out) I'm able to do one arm lockoffs with added weight, board climb v9 & sport+trad climb 5.13 in my early 40s, so about as good an outcome as I would hope.

I'm an N of 1 example so not sure how much of a conclusion you can draw but I think the biggest takeaways for me are that (1) it can be rehabbed but takes a long time and isn't guaranteed (2) the quality of the therapist you work with has a very material effect on outcome.

Good luck!

Josh Swrote:

The MRI said the tear was 50% thickness and the surgeon's take was that this was right on the margin — more than 50% and he'd recommend surgery. I ended up doing one last bout of rehab, this time with Matt Heyliger ( sendagain.co/) who is *by far* the most knowledgable PT I've ever worked with. Over the course of 3-6 months I was able to rehab it completely, so at around the one year mark I had no residual pain. These days (a bit over two years out) I'm able to do one arm lockoffs with added weight, board climb v9 & sport+trad climb 5.13 in my early 40s, so about as good an outcome as I would hope.

I'm an N of 1 example so not sure how much of a conclusion you can draw but I think the biggest takeaways for me are that (1) it can be rehabbed but takes a long time and isn't guaranteed (2) the quality of the therapist you work with has a very material effect on outcome.

Good luck!

I've worked with the worst PTs and some of the best, your words are very wise. Patience and some uncomfortable, possibly painful rehab works more often than not 

Josh Swrote:

The MRI said the tear was 50% thickness and the surgeon's take was that this was right on the margin — more than 50% and he'd recommend surgery. I ended up doing one last bout of rehab, this time with Matt Heyliger ( sendagain.co/) who is *by far* the most knowledgable PT I've ever worked with. Over the course of 3-6 months I was able to rehab it completely, so at around the one year mark I had no residual pain. These days (a bit over two years out) I'm able to do one arm lockoffs with added weight, board climb v9 & sport+trad climb 5.13 in my early 40s, so about as good an outcome as I would hope.

I'm an N of 1 example so not sure how much of a conclusion you can draw but I think the biggest takeaways for me are that (1) it can be rehabbed but takes a long time and isn't guaranteed (2) the quality of the therapist you work with has a very material effect on outcome.

Good luck!

Re-digging this one up.  Josh, could you briefly describe your rehab regime....specifically the content and frequency of your PT, and other types of treatment you utilized during that year?  I injured my elbow climbing last Fall and just as it was starting to feel better, I reinjured a few weeks ago lifting one of my kids up through a slot canyon.  I have a negative hook test and most other clinical indications suggest a partial tear of my distal bicep tendon.  Just curious as to how intense this rehab might be.

Doug Lintzwrote:

Re-digging this one up.  Josh, could you briefly describe your rehab regime....specifically the content and frequency of your PT, and other types of treatment you utilized during that year?  I injured my elbow climbing last Fall and just as it was starting to feel better, I reinjured a few weeks ago lifting one of my kids up through a slot canyon.  I have a negative hook test and most other clinical indications suggest a partial tear of my distal bicep tendon.  Just curious as to how intense this rehab might be.

Hmm it's been a bit so I can't be exact, but to my best recollection:
- we started with isometrics progressing from short to longer hold times, 3x/week
- as things improved we moved to eccentric loading, progressing weight over time, also 3x/week
- a thing he really pushed me on was that tissue continues to remodel for many months post-injury, so he pushed to not give up too early and to continue to rehab until at 100%

In case it's helpful, I worked with Matt Heyliger ( sendagain.co/), and I highly recommend him.

Matt has mentioned "remote assessment" on his web site.

How is this even possible?