What exactly is a distal biceps tendon rupture?

A distal biceps tendon rupture happens when the tendon that connects the biceps muscle to the elbow is torn. This injury commonly affects active individuals, particularly middle-aged men. These ruptures often occur due to sudden strain or heavy lifting. Because the biceps muscle is crucial for arm strength and function, a rupture can significantly impact daily activities and athletic performance.

How does the modified double-incision technique work?

The modified double-incision approach, as pioneered by Morrey, involves two incisions: one at the front and another at the back of the elbow. This technique allows surgeons to directly visualize the radial tuberosity where the biceps tendon reattaches. This direct visualization allows for a more anatomical reinsertion of the distal biceps tendon, potentially leading to better restoration of strength and function compared to single-incision techniques or non-operative treatments. The goal is to restore the tendon as closely as possible to its original position.

What are the benefits and risks of the double-incision approach?

The modified Morrey double-incision technique aims for a more anatomical reinsertion of the distal biceps tendon, which can lead to superior outcomes, specifically in regaining strength. The study referenced in the document, conducted between 2003 and 2015, shows the potential for excellent range of motion recovery. However, like any surgical intervention, there are potential risks. These include nerve injuries like Posterior Interosseous Nerve (PIN) palsy and Lateral Antebrachial Cutaneous Nerve (LACBN) injury, as well as complications like proximal radio-ulnar synostosis and re-rupture. Despite the risks, studies show high patient satisfaction with this technique.

What are the possible complications associated with this surgery?

Potential complications from the modified double-incision technique include a range of issues. Major complications reported in the referenced study included proximal radio-ulnar synostosis, Posterior Interosseous Nerve (PIN) palsy, and re-rupture. Minor complications encompassed intermittent pain, limited range of motion, strength deficits, and Lateral Antebrachial Cutaneous Nerve (LACBN) injury. These complications highlight the importance of thorough patient evaluation, surgical skill, and post-operative care to minimize risks and optimize outcomes.

Who is the modified double-incision technique best suited for?

The modified Morrey double-incision technique can be a valuable option, particularly for young, active individuals seeking to restore pre-injury function after a distal biceps tendon rupture. The decision should be made in consultation with a medical professional, taking into consideration the patient's activity level, the severity of the injury, and the potential risks and benefits of the surgical procedure. The technique's emphasis on anatomical reinsertion may provide advantages in flexion and supination strength, which are critical for many activities.

Illustration of distal biceps tendon repair with glowing sutures symbolizing recovery and active lifestyle.

Bicep Repair Revolution: Is Double Incision the Key to Faster Recovery?

Nico Varela in Health & Wellness December 2025 • 5 min read.

"A new look at an old technique reveals surprising advantages for active individuals seeking optimal outcomes after a distal biceps tendon rupture."

Distal biceps tendon ruptures, though not incredibly common, often sideline active individuals, particularly men in their middle years. These injuries, typically occurring when the muscle is strained against a heavy load, can significantly impact arm strength and function. While various surgical techniques exist to repair these ruptures, the modified double-incision approach, pioneered by Morrey, is experiencing a resurgence, prompting a fresh look at its advantages and drawbacks.

Traditionally, surgery has proven superior to non-operative management for these injuries, especially for those seeking to regain full strength. The surgical landscape includes single-incision and double-incision techniques, each with unique benefits and potential complications. Single-incision methods are favored for their simplicity, while double-incision approaches aim for more anatomical reinsertion of the tendon.

This article dives into a retrospective study evaluating the modified Morrey double-incision technique, examining its outcomes, potential complications, and ideal patient profile. By understanding the nuances of this approach, you can gain insights into whether it represents a reliable solution for restoring strength and function after a distal biceps tendon rupture.

Double Incision: A Comeback Kid?

Illustration of distal biceps tendon repair with glowing sutures symbolizing recovery and active lifestyle.

The modified Morrey double-incision technique involves two incisions: one at the front of the elbow and another at the back. This approach allows surgeons to directly visualize the radial tuberosity (where the biceps tendon reattaches) and facilitates a more anatomical reinsertion. The study, conducted between 2003 and 2015, followed 63 patients who underwent this procedure, assessing their range of motion, strength recovery, and any complications encountered.

The results revealed excellent range of motion recovery compared to the uninjured arm. However, like any surgical procedure, potential complications exist. Major complications included a case of proximal radio-ulnar synostosis (fusion of the forearm bones), three cases of posterior interosseous nerve (PIN) palsy (nerve damage affecting wrist and finger extension), and one instance of a traumatic re-rupture. Minor complications included intermittent pain, limited range of motion, strength deficits, and lateral antebrachial cutaneous nerve (LACBN) injury (affecting sensation in the forearm).

Excellent ROM Recovery: Most patients regained near-full range of motion in flexion and extension.
Potential Nerve Issues: PIN and LACBN injuries were observed, highlighting the risk to these nerves during surgery.
Strength Deficits: Some patients experienced minor strength loss, particularly in supination.
Synostosis Risk: A rare but serious complication involving bone fusion.

Despite these potential complications, the study participants reported positive outcomes. The average DASH score (measuring disability in the arm, shoulder, and hand) was 8.5, indicating relatively low disability. The Oxford Elbow Score (OES), assessing elbow function, averaged 41.5, and the Mayo Elbow Performance Score (MEPS) was 96.3, reflecting excellent overall elbow performance. Patient satisfaction was also high, averaging 8.9 out of 10.

The Verdict: Is Double Incision Right for You?

The modified Morrey double-incision technique appears to be a valuable option, especially for young and active individuals seeking to restore pre-injury function. Its strengths lie in facilitating anatomical reinsertion, potentially leading to improved strength in flexion and supination.

However, this approach is not without its risks. Nerve injuries and synostosis are potential complications that require careful surgical technique to avoid. The study emphasizes the importance of performing the surgery within two weeks of the injury to prevent tendon retraction and recommends that only experienced elbow surgeons undertake this procedure.

Ultimately, the decision of whether to pursue the modified double-incision technique should be made in consultation with an orthopedic surgeon. Weigh the potential benefits against the risks, considering your activity level, desired outcome, and the surgeon's experience. With careful patient selection and skilled execution, this technique offers a promising path to recovery after a distal biceps tendon rupture.