Biceps Tendon Lengthening

The Bicep Tendon Lengthening (BTL) is a surgical procedure to alleviate elbow flexion contractures, about an average of 25° and improved length, sometimes almost to normal, and improve the upper extremity functions. 

Biceps Tendon Lengthening is performed using a Z-Plasty technique on obstetric brachial plexus injury patients, who have had diagnosed biceps tendon fixed flexion contractures. Ulnar, radial and median nerve decompression was also performed at the same sitting. The surgery is performed under general anesthesia. An incision is created over the volar elbow crease to expose the underlying biceps tendon, the brachialis muscle fascia and the median and radial nerves. The laccertus fibrosus released sharply. The biceps tendon is dissected proximally and distally, then sharply released in a z-fashion, allowing improved passive extension of the elbow joint. 

The radial, median and ulnar nerve contractures are released using internal and external neurolysis to improve finger and wrist flexion and extension. The brachialis fascia is exposed and a series of step-lengthening fascial releases are performed to lengthen the brachialis muscle (included in Z-Plasty). Partial release of the collateral ligament is also performed. 

Following surgery the patient is placed in a cast that extends from mid humerus to mid forearm. 


1. Evaluation in Houston office (no charge for initial consultatation)

2. Telemedicine, submit all medical records to the office with video 

3. Outreach Event evaluation for in person evaluation free of charge (must bring documentation if required for condition)


Infants can be evaluated by video, simply remove clothing to the waist and show spontaneous movements of both arms while lying on the back. You can of course also have your child evaluated by Dr. Nath in person. Please visit and sign up for our email list to see when Dr. Nath will be in your area next.  

We also able to schedule a visit with Dr. Nath in Houston, please contact our office at 713-592.9900. 

In the interim, please contact our staff therapist Cindy Servello. via email at  She will contact you and would be happy to answer any questions you might have.  


We also need to see any medical records pertaining to your child’s injury, specifically previous surgical reports, CT or MRI reports and images, EMG (nerve conduction study) results and serial casting. The records may be faxed to 713-592-9921, emailed to, or mailed to Texas Nerve & Paralysis Institute, 6400 Fannin St. Ste 2420, Houston, Texas 77030.

Please also fill out, sign and submit the Consent Form .  This must be included with all documentation prior to Dr. Nath's review of the records.


Please send us a video or photos showing your/your child’s current range of motion using the movement chart shown.  All movements should be included with a maximum of 30 seconds time. 
Please have someone film you/your child wearing a tank top or sports bar, so that the shoulder blade is visible.

Videos taken on camera phones may be emailed to Videos taken on regular video cameras may be uploaded to our website due to large file size. 

Click below for video upload: