I’m writing to hopefully find some answers to my questions about Distal Bicep Surgery and the appearance of the bicep post surgery with regards to recovery. I ruptured my left distal bicep March 1st from a fall but the bicep didn’t appear retracted until 6 weeks later, so I’m assuming it was a partial tear that eventually got worse. I had the endo button reattachment surgery April 25th at 8 weeks post injury and the surgeon said everything went well, but I noticed there is still a gap in the bicep where it meets the inner elbow about 1-2 cms more than my right arm. The recovering bicep feels loose as well and it’s difficult to fully flex, but it’s slowly coming better and has gained some size and shape. I’m concerned that the tendon wasn’t reattached in the proper place resulting in this remaining deformation, or that maybe something came loose during my rehab. My questions are is it normal to see a residual gap in the bicep after surgery at 11 weeks post op, and is this just muscle atrophy from disuse where I haven’t really trained hard since injury March 1st ? Some people I’ve spoken to who’ve had this surgery said it’s normal and not to worry, that in time once I’m able to train with moderate to normal weight I will see a big improvement, but it’s still very mentally consuming wondering if something might be wrong with my arm. I know that the standard protocol is to drill into the radial tuberosity, but is there a margin of allowance where the tendon is inserted or is it straight forward and common practice ? I’m also seeing a different shape to my forearm, the brachial muscle seems to bulge out to the side more than it ever has in the hammer position, and I still have some numbness in my forearm down to my thumb and index finger and partially on my hand. I’ve been bodybuilding 28 years and competed a few times, but I’ve never had a muscle injury of this level. I’m using very light weight for arm training until I see the surgeon in 12 days for my 12 week follow up where I will ask some questions about my concerns. Thanks for reading, and I appreciate the Advice and feedback
Hey man, I’ll do my best to be thorough here with my response. What you are seeing regarding a difference in the gap is very normal. More often than not, an aesthetic difference remains even after a repair. That does not mean the repair has been compromised. 11 weeks is still relatively early in the rehab process after an injury such as this and I would still expect a big strength deficit to be present. As you return to training and regain strength, that deficit will become less apparent. What you are seeing in your forearm is also typical and it will take a few months before the side to side differences are not as apparent. Overall, I would still expect a ~40% deficit side to side in strength. With your background in bodybuilding I have a feeling your observation for differences is honed more than most, but everything you have said is exactly where I would expect someone to be at this junction.
You have some cutaneous nerves in the area near where the incision is typically made and numbness happens occasionally. This does return but more often than not it gets less numb over time and sometimes there will even be some phases of hypersensitivity as it heals.
Thanks for the explanation Derek. I guess I was hoping to see more improvement in the appearance of my bicep at this point even though I know it’s very early, but following quite a few athletes who posted their progress videos on YouTube, I haven’t seen them report any similar concerns about this residual gap I’m seeing especially early on in their recovery, so when you feel like you’re in the minority, you can’t help but question why after the surgery that I still see this alarming gap which was how I knew it was torn in the first place. I met with the surgeon yesterday and he said everyone asks the same questions I did, and he came right out and said for me to “stop looking at it” ! My visit was quite short, his clinic was extremely busy so I didn’t get to ask all the questions I wanted to. He cleared me to start training with moderate weight and just said to listen to my body and don’t overdo it. And You’re right, I still notice weakness in my recovering arm but I’m taking it slow concentrating on ROM and full extension of my arm in hopes the tension will eventually help lengthen the bicep down to the inner elbow, but I have my doubts. I want to Thank You once again Derek for taking the time to write. It’s reassuring to know I’m not the only person to have the same concerns after this kind of surgery. Hopefully in a few months I’ll see some progress !
Six months post op update : The bicep has increased in size and training has become somewhat more in line with my normal regime. I’m lifting about 60% of what I normally lift for biceps training. I still don’t feel confident to curl much more just yet, plus I had a set back 2 months ago where my forearm pain was extreme and inhibiting every day use which required me to take ibuprofen for a week, but that has subsided and the forearm discomfort is more tolerable lately. The bicep length hasn’t improved much, however, and I fear it’s going to be this way from now on. At full arm extension I’d say there is an inch deficit where my bicep doesn’t fully fill into the elbow like it did pre injury. I can’t seem to find anyone else personally with this condition which is quite disheartening and none of the numerous documented YouTube videos appear to have this either, so either my surgery didn’t quite go as well as I’d hoped, or I just need more time, but I can’t see the latter being the case here. Someone said to me don’t believe all the people on YouTube, that you never see people praise themselves when recovery doesn’t go to plan, perhaps I’ll be the first. I’m 29 years training, 3 bodybuilding shows where I last won the provincial middleweight title and was featured in MuscleMag International given the name MINIHULK, so you can probably see why I’m disappointed with this recovery and lack of attention by my surgeon. Please respond if anyone has insight and further recommendations that can help lead me to some answers and hopefully some light at the end of all this. Thanks !
8 months plus into recovery update. My recovering left bicep measured 17” cold in the curled flexed position compared to 18” on my right, so 1” smaller overall where it was usually 1/4” smaller before the tear. Bicep length has shown very slight improvement but it’s still noticeably short at full arm extension by about an inch. I trained arms yesterday and with a full pump the difference isn’t as noticeable, but it’s only temporary and returns to this new normal afterwards. Strength is about 65% as I don’t feel comfortable to push much more than that due to discomfort and fear of tearing the tendon again. Relaxed with arms at 90deg resting on the table I can see my left bicep sags a bit and feels loose compared to my right. The uncomfortable forearm numbness and back of the hand and thumb tingling lingers for several days especially after I train back or biceps. It extends down to the tendon attached to my thumb along my wrist and supination as well as pronation feels strenuous. I firmly believe something isn’t right, my surgeon dismissed all my concerns last month during my 7 month follow up appointment saying I’m only concerned about the aesthetics and I can’t get anyone to give me a second opinion or call for another x ray or MRI to look into it. Very frustrating knowing I’ve done everything according to protocol and being extra careful not to re injure myself and have results like this. I’ve researched over 25-30 individuals and spoke with several local bodybuilders who’ve had this surgery and nobody had results like this. I’m at a loss for understanding why I’m behind in this recovery especially someone who trains smart and gives himself the best in nutrition for close to 30 years.
I am curious as to why you think these are not good results? At 8 months, an inch deficit would be well within normal limits and from a percentage based you’re at almost 95%. If anything that is a testament to the work you have put in. It sounds like some of the strength issues are self-limiting out of fear at this point, which is understandable. There does tend to be a point in most people’s recovery process where the mental game of intensity ends up as the rate limiting step. This tends to subside as you get more comfortable training heavy again. That being said, for some perspective think about how long in your own training regimen it took you to get your arms from 17 to 18". I highly doubt that was an 8 month process as the closer you get to 100%, the more you are going to see diminishing returns.
I just expected the bicep length not to be an issue at this point. Everything I’ve researched about this surgery described the opposite of my own experience, where the tendon is cut shorter than it was naturally for a clean and healthy reattachment, if the tendon is placed back in the tuberosity where it naturally sits, everyone I’ve corresponded with reported a very tight feeling when fully extending their recovering arm due to the added tightness pulling on the biceps. Mine felt the total opposite all along and visually I can’t help but see the correlation to that feeling when a 1” gap at the inner elbow now exists. Initial MRI showed I was only 13 mm away from the radius so pulling the tendon down wasn’t an issue, but the timeline from injury to intervention is the biggest factor where I was a bit later than most having the surgery due to me being unaware of the damage at the time plus the fact that it may have only been a partial tear that worsened weeks later. You’re right though Derek, I have put in the work to get to where I am currently and I never give up ! That’s probably one of my greater strengths along with my greatest weakness in this case, the never ending quest for self improvement
I’m 6 weeks post op distal bicep surgery the bicep seems still a little deformed surgeon said the tendon was probably stretched out has anyone heard of this when I can start training again will the size even out ?
I also recently had distal bicep surgery with a large post op gap. I also had my surgery later than expected, about a month out from injury. I’m about 4-5 months post op and haven’t really been at gym since.
My first post here. I have excatly the same problem. I tore the tendon of the bone in my right arm (primary) back in november 2020. It was a horrible experience, and my first surgery ever. I had surgery on the 10th day of the rupture. I was put in a cast for three weeks, and my legs almost gave way under me when I saw the the arm and the incision points. However, I could almost stretch the arm completely following the removal of the cast. No ROM brace or anything. Now, five months later, I am getting more and more frustrated with the length of the bicep. Both my biceps were always long and nice, and now I have a short biceps on my right arm. I can’t stop thinking about it - and I am not a bodybuilder. I used to do bodybuilding in the 90’s, but switched to other stuff. But still - it’s a vanity point.
Did MINIHULK figure something out? I can tell you guys one certain thing: I am not going under the knife again to make it longer.
Hi there guys. Been a while since I checked my own post and just seeing some activity today. I’m approaching the one year mark since my surgery on April 25th. Currently I’d say I’m about 80% of where I was before the injury. I don’t expect to regain full strength and aesthetics at this point, I fully believe there was an error made during the surgery whether it was improper placement of the tendon on the radius or perhaps the muscle fibres were accidentally cut near the end of the tendon which resulted in a shorter outer bicep head, either way I still have about 1” increased gap at the insertion point where my bicep meets my forearm at full arms length extension, and I don’t feel the same tension on the bicep as my other arm, it feels loose in comparison. When I flex both arms it’s not as noticeable but it’s still there, and until now I was one of the very few people I could find reporting this. My surgeon didn’t care about my concerns, there was no explanation, and I’ve done everything I can to train the arm to regain its strength and shape, but this is about as good as it gets. Personally I don’t think I’d get another surgery done again unless I was having major issues, and my competition days are done anyway, so I’ll learn to live with the deformity, but I can totally relate to anyone who feels disappointment with results like this considering most report a much better outcome. From my experience I would highly recommend seeking out the best surgeon available with lots of experience and positive feedback for this kind of procedure as it is very important they take care to ensure the bicep insertion and length are optimal, otherwise we have people like ourselves always questioning what went wrong, because it is indeed mentally straining no matter if you’re a bodybuilder or not. Well, I hope that explains things a bit better from my perspective. Take care guys and I wish you well with your recovery !
Minihulk, thanks for the feedback and the pictures. My arms are normal (from a muscle size perspective) so I won’t bother you with pictures - unless they are requested :). I switched to weightlifting in the 90’s, then kendo, then boxing. The latter is the source of my injury. I should stress that I got the two-incision repair with two anchors.
I think I might be slightly worse off than you. Is it possible to see pictures where you flex the bicep with the palms facing outward? I mean, to get the “long” bicep look.
Also, could you advice on which training exercises I might use during this time? Right now I do normal curls and hammer curls with 8-9 kilograms.
I’d keep doing those exercises but concentrate more on the outer head by choosing a close grip barbell curl and higher reps with no forced reps, just listen to your body and don’t overdo it. You already know that the hammer curl elongates the bicep the most so that exercise will help lengthen the bicep for sure. Personally I like to stretch the arm a lot which may have helped improve the length issue I was having but even then it can only do so much and I still have a noticeable to me difference between both arms when I’m standing relaxed but I’ve seen a lot worse.
Minihulk, I have just the same problem as you do. Just a gap, loosen biceps, it all is as you described. I ripped my biceps in november and recieved surgery eight days later. It’s supposed to be everything ok but actually it’s not. I have been reading some literature because of the injurya and found a type of failure that fixes completely with my sympthons. As far as i have read some attachments slides out of the radial tuberosity and the tendon is hunging only by the thread. In my case it explains the gap, the normal motion in supination but a lack of strength and the visible tendon on my forearm with a biceps displaced outside. We will be written down as succesfull cases in literature if we don’t identify the problem. I will make myself as many tests as necesary and will get surgery again if I finally am right.
I too have a very noticeable shorten bicep after surgery. It has been 7 weeks since the surgery. I was in a cast for 4 weeks. After the cast was taken off I had full range of motion in wrist and elbow. I have been involved with competitive bodybuilding/ fitness community for over a decade now and know several people that had same surgery but I’m the only one with shorten bicep. Have an appointment scheduled in a couple weeks with a different orthopedic surgeon to see if anything can be done. The original surgeon was not concerned at all about the asymmetrically arms. Been trying to find other people that experienced this. This is only forum that I have found
I read this forum just before my revision repair after a bad surgery so thought I would share my experience. I experienced exactly what you guys had, shortened bicep after surgery 2 inch gap looked ugly and deformed I couldn’t stop looking at it with depression and sadness. When I shared my concerns of deformity and pain to the surgeon he brushed them off and said come back in 2 months. I went to a private surgeon instead who is one of the best in the world, got an MRI he then said the tendon wasn’t fully attached and the last surgeon threaded the sutures incorrectly through the forearm muscle. I had revision surgery and the bicep looks pretty much normal to pre injury cosmetics although there was some minor damage at the muskulotendinous junction but that could have been before the surgery but I’m guessing the first incompetent surgeon could have done it too so you can see a minor divot but not noticeable to the average joe. The shortened bicep is usually a sign that the tendon isn’t fully attached to the bone. I would get an MRI done the revision can be done months if not year after the surgery. Mine was done 4 months after the surgery. I’m 3 weeks into the revision surgery and I am much happier with the cosmetics. Before there was a 2 inch gap and my bicep was short and ugly, now it is barely noticeable and feels much stronger. Im looking forward to rehabbing it soon at 4-6 weeks and seeing how it looks then. Good luck guys and always spend extra on the best surgeon in your area, not cheaper or free healthcare like I did.
UPDATE: fast forward 2 and half months post revisionsurgery, there is still a half inch difference but the bicep is much smaller than the right as I haven’t regained full strength yet, and the previous surgeons confirmed there was some damage at the musculotendinous junction where the muscle slipped back a bit. This happens on many bicep tears which is why even though the tendon is usually fully attached to bone the muscle is a still a little shorter. Either way it is much much better than the first surgeon who completely screwed up the surgery and the bicep was easily 2 inches higher up. I also have some inner brachioradialis pain it that is likely to be damage which the first crappy surgeon did when he damaged the muscle, or could be scar tissue in my tendon that needs strengthening. But I am getting strongest every week so not concerned.
Now from the front pose you can’t tell the difference only relaxed at the front and side. Even then the average person will have no clue. I am also confident once full size is back in the arm would be even less noticeable.
remember guys my case I just felt it was all wrong from the start, in most cases if your bicep is slightly shorter it’s because there was some damage done at the musculotendinous junction not because the surgeon did a bad surgery. But if anyone who has recently injured or torn their distal biceps, always go for the best surgeon in your area don’t cut corners with a cheap crappy young surgeon.
