Dr. Kurt Gasner from the Jewett Orthopaedic Clinic

How I had surgery to repair my right distal bicep tendon and became the Six Million Dollar Man. Okay, the Five Thousand Dollar Man.

It began with a *pop*. Well, it began when I agreed to help my friend Vannah move into her new apartment, and then it technically ended with a *pop*.

Could you say no to this face?

Could you say no to this face?

As I lifted the bureau into the back of the U-Haul, I felt my bicep stretch and move in a way that it shouldn’t. There wasn’t any pain, but my whole arm felt weird, and when I straightened my arm, my muscle undulated under my skin like an alien.

After consulting with my medical team, which consists of my mother and a friend who is a sports medicine doctor, I came to the completely uneducated conclusion that I had torn my right bicep tendon at my elbow, an injury that is relatively rare, as less than 5% of bicep tears occur at the elbow versus the shoulder. Once the bruises appeared a day or two later, I knew that I was right in my self-diagnosis.

Bruising after tearing the right distal bicep tendon

I went in for an appointment at the Jewett Orthopaedic Clinic and met with Kurt Gasner, MD, a specialist in Orthopedic Surgery and Surgery of the Hand and Upper Extremities. Dr. Gasner was fantastic, rejecting my insistence that he was actually Academy Award winning actor Richard Dreyfuss, yet still taking the time to explain how the bicep tendon attaches at the elbow and why surgery to repair it is extremely important. While I’d still retain strength, thanks to the redundancy built into our bodies, the ability to turn my wrist and lift weight in a flexing motion would be reduced significantly. Since I assumed this meant that my ability to masturbate would be severely affected, we scheduled surgery to repair my right distal bicep tendon immediately for the following Friday.

Dr. Kurt Gasner from the Jewett Orthopaedic Clinic

After determining that normal anesthesia wouldn’t work, the anesthesiologist brought in a gorilla tranquilizer, which seemed to do the trick. I also had what’s called regional anesthesia, which is a block that was inserted to prevent the pain receptors in my brain from feeling pain as the surgeons worked on my arm. With the block inserted and the sedative about to kick in, I was ready to go.

Adam Avitable in the operating room before bicep tendon repair surgery

WARNING: All images after the following photo are of a graphic nature, with close-up images of the surgical process involved in repairing a distal bicep tendon. If you faint at the sight of blood, if you are pregnant, if you are subject to projectile vomiting, or if you are under the age of 13, you may want to click away now. Otherwise, continue at your own risk.

Dr. Gasner wrote his initials on my arm to confirm that he was operating on the right body part. He also sketched out the incision and completely ignored my request to make it into a happy face.

The incision is drawn onto my arm

Once the incision was made, Dr. Gasner had to reach inside my arm and find the distal bicep tendon where it had curled up inside my arm after snapping. With his finger, he cleared away scar tissue and used the clamps to slowly unroll and extend the tendon to its proper length.

My distal bicep tendon is retrieved and stretched out.

Once the tendon had been fully extended, Dr. Gasner threaded it with a fiber that looped in and out of the tendon until it held it securely. I wasn’t aware until after the procedure how much this was similar to sewing. I’m pretty confident that Dr. Gasner crochets a bad-ass quilt, too.

The tendon is securely threaded with a fiber wire.

After the distal bicep tendon had been threaded, a drill was brought in to drill through the bone. Also, my arm now looks like the pit of Sarlacc from Star Wars. Where’s Boba Fett when you need him?

A hole is drilled in the bone to install the corkscrew anchor

Once the holes had been drilled, two small corkscrew anchors were threaded with the same ¬†fiber. They were carefully inserted into the holes in the bone, and then turned so that they locked in place, much like a button would do, if it was made of metal and tiny and used to hold your tendons in place so you don’t flop around like a sad broken old man.

The suture is pulled tight through the anchors, which attaches the tendon to the bone.

Once Dr. Gasner inserted the anchors, he pulled the fiber tight until my distal bicep tendon was back where it belonged, and tied off the suture in what I imagine to be a very pretty bow.

The tendon is now attached to the bone through a secure toggled anchor

A few stitches later and Dr. Gasner gave it the thumbs-up before leaving to go do what doctors do after they’re done with another successful surgery, which is probably to laugh mightily and proclaim to the heavens, “I AM GOD”.

Post-op Right Distal Bicep Tendon Surgery

The entire procedure to repair my right distal bicep tendon only took about an hour and fifteen minutes. When I came to, I felt immediately alert and normal, except for the giant splint around my arm and the fact that my entire arm was completely numb.

Adam Avitable awakens from surgery to repair his right distal bicep tendon

The recovery time has been very quick. My fingers and arm regained feeling after about 24 hours, and I spent a week in the splint. My pain levels were very low – in fact, I only took three Percocet total, and the only day that I got whiny was on the Sunday immediately following the procedure.

One week after the procedure, I got the splint removed and was able to start moving my arm and twisting my wrist until I’m back to normal, a recovery process which could take as long as three months. I expect to be able to begin masturbating again immediately, though.

I’m writing this post to act as a reference for anyone who may have had this happen or for anyone who may be considering having surgery to repair his or her distal bicep tendon. For anyone in Central Florida, I would wholeheartedly recommend Dr. Kurt Gasner and the entire staff at Jewett Orthopaedic Clinic, as they were efficient, friendly, informative, and provided an easy surgical experience for me.

Also, if anybody else needs help moving . . . call somebody else!

74 thoughts on “How I had surgery to repair my right distal bicep tendon and became the Six Million Dollar Man. Okay, the Five Thousand Dollar Man.”

  1. I enjoy looking at those kinds of photos. I think I was a dermatologist in a past life.

    I’m about to have my ACL and Medial Meniscus repaired with, hopefully, similar success. Except that I don’t masterbate with my knee.

    Glad it worked out for you Adam!

  2. WHEN YOU TELL ME NOT TO LOOK, I AM COMPELLED TO LOOK! Now I am in a state of trauma and trying not to puke. Thanks so much for that (and the people sitting near me at the airport thank you as well!).

  3. That was so cool! It’s amazing how they can do all that in a little incision. If it were me doing the surgery, I’d probably have to open the whole arm, so it’s probably a good thing I’m not a surgeon.

    1. I forgot to mention to him that I was even having surgery on it. The staff is used to taking photos because it can be used for articles and for informative purposes, so it was no big deal for them to take photos for my own needs.

  4. Gnarly, dude. But cool. Who took the pics? I’m guessing you thought of wanting to blog this and enlisted a friend? Perhaps I’ll find the answer in comments…

  5. Maybe I should post the photos of my recent colonoscopy!

    Really cool that they were willing to take pictures. I would have thought they would be concerned with the liability if your phone “disappeared” for some reason.

    1. They were really relaxed about it – I think because it was an outpatient procedure for only an hour, and that they take photos all the time for their own research, they were okay with it.

  6. I experienced exactly the same injury three weeks ago, however as we have the National Health Service here in UK it is a longer wait for the surgery, but now i see it close up looking forward to my own set of photos. Glad you recovered well…….oh and your right about the pain easier to man up than take some grog inducing pills!!

  7. I was wondering if you could still move your arm fairly well after it tore(before surgery). I’m thinking I have a minor tear. Huge bruise that would indicate my thinking but military doctor thinks it’s just a bruise. It’s been 11 days and it’s starting to feel worse and my shoulder is starting to hurt a little bit. Just curious if you could still do a pushup or did you have a full rupture? I’m thinking about a second opinion as I know this surgery should happen fairly quick after injury. I have the bruise on my forearm but a lot worse and bruising up the inside of my bicep.

    1. I was able to move my arm completely – I just had pain if I twisted it a certain way or tried to lift anything heavy. My shoulder never hurt, though, so you may have a different type of injury. And I never did pushups either way. :)

      1. I also had a huge bruise. However I had a full rupture but could still do a few push ups. It was any twisting movement that caused pain and my should was also in pain for a few day’s. I elected not to have the surgery 10 days ago and find I am experiencing an improvement every day. A decrease in pain and much more movement, but this is now 6 weeks since the injury.

      2. On the pit of the elbow my arm is really tight and like you said if I twist my hand a certain way it hurts too. Nothing terribly painful but really tight with a little pain. Bruise is almost gone now too. If you can do a pushup then there is nothing wrong with you. Military mentality.

  8. I’m one week removed from my right bicep tendon rupture. I wish I didn’t need the pain meds. My first 48 hours crushed me. Ive experienced an Achilles rupture 4 yrs ago and this has been more painful. How long before you had full range of motion? I have trouble getting a fork to my mouth and masturbating. Hoping less than another 7 days. Just scheduled a tee time for next Monday

  9. This is Mitch, Megan Gordon’s husband, I ruptured my left bicep tendon at the elbow last week. While looking up the pros and cons of having or not having surgery I came across your post. I am set to have surgery next week to reattach the tendon. Wondering how the recovery is Going? My doctor said it would be about a year recovery.

  10. I had the button surgery about 10 weeks ago. New surgery for here in Denver. A few days in a dressing. But, the rehab has been interesting in that the Physical terrorists have no idea what to do with me. There is no protocol for this they say. I have slowly been increasing my weights and trying to mimic what I will be doing once I go back to being a Paramedic in a busy system.

    I am interested in finding if anyone has or can direct me to some literature on a Physical Therapy protocol or work-out. I am afraid I might rupture it again and be out even longer. Being 10 weeks out i am able to curl 12-15lbs, do all my theraputic band exersices and a few things I have put together as a work out, but again no protocol im just winging it.

  11. Avitable,I had the surgery 10 weeks ago and am still numb from thumb to elbow.about a 2 inch wide strip. How long to go away for this? Also how long for the muscle to fill back in? I have a short looking muscle,looks like it did before the surgery. Does this come back? Thanks

  12. I had my surgery and have had 4 weeks of PT.I still can’t move the last three fingers on my hand.I go back to Dr. this week he wants another MRI before the appointment,Don’t know what to expect.

  13. I had the surgery to repair a complete distal bicep tendon repair about 3.5 weeks after i pulled it loose. The surgery went well…they used the anchor n button style repair. I had pain before the surgery in my shoulder and elbow. My arm would fatigue really fast doing simple things ….like dishes or folding clothes or masrterbating. More of a cramping type pain. 2 weeks after surgery they unwrapped it and most all of the pain was gone, I had pretty much full range of motion back. Im 4 weeks out of surgery and it is still tight if i try to straighten my arm…and sore if i move it certain ways….like twisting …curling type movement…pulling…ect. I am a smoker so they say i dont heal as well. I had a hard time getting a surgeon that would do the repair because I smoke. All things considered I am happy with the results. My bicep is back where it should be n nuthn is floppin around in there.

  14. My main question is: How is Vannah’s new apartments working out?

    But while I’m here, (1) can you tell us if the switched you to a removable splint after the first one came off? (2) Did the surgeon discuss the options with you before deciding on the anchors? (3) Is it your impression that the attachment to the anchors is the permanent attachment or is it just until the tendon reattaches to the bone (and the “thread” eventually dissolves)?

    My procedure was similar but instead of the anchors they drilled the two holes all the way through and tied the “thread” off on the other side of the bone. That required a second incision on the opposite side of the first. They gave me a removable splint after 10 days but seemed shocked that I stopped using it after a few weeks — as if the whole procedure might become a failure because of it. In my case the intent definitely is/was that the end of the tendon will bond to a depression they created in the bone. The thread is just to hold it there until the tendon/bone meeting point gets covered over with bone, etc.

    1. For anyone who is concerned about why they got a tendon rupture when they did —

      a) My tendon rupture came a few weeks after using the antibiotic Cipro. I have since learned that Cipro is “associated with” tendon rupture and carries a significant warning box at the top of printed and web information about the drug.

      The exertion that ruptured my bicep tendon was trivial compared to what I consider “heavy”.

      b) Also it is not just any exertion of the bicep that might result in the injury. It is exertion that starts with the arm already fully extended (when the tendon is already under tension).

    2. Hi Mike. Your post-surgery circumstances were much closer to mine than Adams, please see my comments below. As for your #3 question, the last part of your post describes our situation correctly: the sutures bio-absorb and you’re left with a useless little anchoring plate – but it won’t set any alarms off at the airport. By the 6th week, I’m told that the tendon is holding to the radius all on its own.

      And I do cheat with my splint – I take it off as I work at my desk (I test software) but I put it back on when I’m mobile. My PT tech told me about the guy who wasn’t wearing his brace/splint, and absentmindedly went to pick up his luggage from the airport carousel while on the phone with his left hand. *POP!* – he had to go through the process all over again. I could not image. And he was 6 weeks post-surgery. I’m terrified to be *that* guy.

      1. Thanks for the info.

        While they were disappointed that I had stopped using the brace they did seem surprised at how good my range-of-motion was (several people in the room raised their eyebrows when I showed how my supination was coming along). Turning your hand from palm-down to palm-up is actually done by the bicep and is something your should not do in the early stages of healing (unless aided by your other hand). I think not wearing the brace has everything to do with my range of motion recovering so well. But then again, I realize that the risk of reinjury was high during previous weeks. I feel sorry for the guy at the airport… especially since the 2nd time around sometimes calls for a piece of tendon to be taken from elsewhere and grafted to the repair site. Sounds horrible.

        At 10 weeks they told me I could stop wearing the brace (as if they still didn’t get it) and that I could start doing light isometrics with the arm. At 12 weeks (which is tomorrow) I can start doing light resistance training with the arm. Elsewhere on the web I have read that at 16 weeks the healing is pretty complete.

        1. Interesting indeed. The human body is an amazing piece of machinery and your progress doesn’t surprise me. All the brace does is keep you from putting pressure on the fixed tendon in such a way that prevents an easy re-rupturing. I’d say there was a bit of luck on your side, my man. “In the moment”, anyone could pick up a toddler, a 5-gallon bucket of paint, of a piece of luggage without thinking about it. Even after my ortho brace comes off, I’ve ordered a neoprene elbow brace to serve as a gentle reminder to not pick heavy shit up with my dominant right arm.

          Thanks for your info as well and I’m glad it’s all coming along well for you!

    3. Sorry that I didn’t reply in a timely fashion, Mike. My impression was that the anchors is a permanent attachment – he was using filament wire, not thread, so it was not designed to dissolve. I switched to a simple sling after the first one came off, and the method of using anchors was never discussed.

      1. Then the monofilament would explain your ability to move your arm around more. I guess lately, more docs are using the dissolvable sutures with an anchor – which leaves a period where the tendon is not fully fused to the bone and the sutures are almost dissolved. I’m getting ready to enter my 6th week post-surgery and I’m still braced. :-)

  15. Well, well. Talk about close to home. Literally and figuratively. I too was helping someone move in late December, I too heard (and felt, to the point of almost hyperventilation) the POP. I am also in CFL and seeing Dr. Deren at Jewett. My tendon partially broke so I didn’t get the “Popeye muscle” of a full dis-attachment nor did I get any bruising. Supination hurts like a mofo. My surgery is this Thursday, and I’m terrified of the loss of joint usage for an extended period. I appreciate your blog and it gives me some measure of relief in knowing more of what to expect.

    It also concerned me when the doc said that tears as they appear on the MRI are almost always worse when he gets in there and looks at the damage.

    And I couldn’t agree more – I’m never helping anyone move ever again. Thanks for the info, I hope your arm is back to near 100%.

      1. Thanks. And I really wanted to thank you for putting this blog together. It was a great resource for me, pre and post surgery. With all of us posting different experiences and observations, that many more will be helped by it.

  16. Detached my right bicep at the elbow two days ago. Didn’t realize how screwed I was until i took my jacket off and saw that my bicep was missing. I really appreciate the humor and the photos. Like you I’m a sick SOB who likes to record these things. I’ve had way more than my share of surgeries and always appreciated surgeons that have the humor needed to take pics etc, for me it displays confidence and I like cocky confident surgeons… don’t want any wimps sticking a knife in me… Having surgery this week. I’m on the west coast or I’d seek out your guy.

    Best of luck!

    1. Hey there Glen.

      I guess Adam isn’t maintaining this blog anymore. I wanted to weigh in since my last post here (just before yours) as I’m towards the end of the post-surgery healing phase and in regular PT.

      When I read this blog before my surgery, I had a different idea of what to expect after the surgery was done. I had the same big jalopy on my arm that Adam did after surgery. I got it off after a week too, but the similarity ends there. The nurse then put a sturdier fiberglass one put on for two more weeks, that went from my hand to just below my shoulder. When I got it off two weeks later I was immediately sent for a custom-fit removable brace that keeps my arm at a 45 degree angle. They only wanted me to take it off only for PT (or showering, but I was instructed to wear my sling whilst doing that). So, here I am on my 5th week out of 6 that I’m supposed to keep my arm mobilized.

      So needless to say, I found it rather odd that Adam only had his arm mobilized for a week, especially when we had our surgeries at the same organization.

      Maybe you won’t have as much mobilization as me, maybe you will. I guess it depends on the doctor and how he/she does the procedure. Speaking of, my doctor was far from what I’d call ‘confident and cocky’, but he’d done thousands of these procedures. I’ll take successful mileage over cocksurety any day. :-)

      Good luck with your procedure.

      1. I don’t reply often anymore, no, but I still see everyone’s comments. I’m not sure if you and I had a slightly different issue, but I just had to avoid putting any weight on my arm after the first week and kept it in a cloth sling for a few weeks, and then was able to move and use it like normally, albeit gently, after that.

  17. Thanks guys. I had my surgery, and as expected, I was in for a whole new definition of pain… The incident didn’t really hurt that bad, my pain experience is lengthy, so in comparison to some of the other stupid shit I’ve done, this was not bad. Post surgery was a different story, percocet round the clock for the first 4-5 days, then just advil during the day until I got home from work, then percocet again. I’m now two weeks post surgery and the pain is bad but tolerable during the day… I was never put into any cast or brace and don’t anticipate doing so based on the doc’s comments. He doubled up on the little button device, said it was due to the relatively larger bicep, always had big arms. I wear a sling when I’m in public so no one tries to shake my hand or whatever, and helps remind me to not use it.

    Anyway, I know there’s still a long road to recovery.

    Thanks for all the info guys, very helpful.

    Take care,

    Glen

  18. How long was it till you were 100% back to normal? Did you only have the cloth sling? Or did you have a bunch of different braces like the other guy was talking about??

  19. Take care… I have the same problem. I decided to not do the surgery. I don’t have pain. I can move my hand as nothing happened…The MRI concluded the rupture of one of the two joints ” distal biceps tendon”. Same symptoms as yours.
    Now as the anesthesia is not general…I definitely changed my mind since it is local (I am over 55years)
    thx for the clarifications.
    Br

  20. Can anyone help me out ? I just did my surgery on Wednesday And here we are 3 days later and I can not fully extend my fingers. Starting to get a little scared. Any info would be great thanks !

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