Simultaneous bilateral distal biceps tendon repair: case report

Abstract

Simultaneous bilateral rupture of the distal biceps tendon is a rare clinical entity, seldom reported in the literature and with unclear therapeutic setting. The authors report the case of a 39-year-old white man who suffered a simultaneous bilateral rupture while working out. When weightlifting with elbows at 90° of flexion, he suddenly felt pain on the anterior aspect of the arms, coming for evaluation after two days. He presented bulging contour of the biceps muscle belly and ecchymosis in the antecubital fossa, extending distally to the medial aspect of the forearm, as well as a marked decrease of supination strength and pain in active elbow flexion. MRI confirmed the rupture with retraction of the distal biceps bilaterally. The authors opted for performing the tendon repairs simultaneously through the double incision technique and fixation to the bicipital tuberosity with anchors. The patient progressed quite well, with full return to labor and sports activities, being satisfied with the result after two years of surgery. In the literature search, few reports of simultaneous bilateral rupture of the distal biceps were retrieved, with only one treated in the acute phase of injury. Therefore, the authors consider this procedure to be a good option to solve this complex condition.

Functional Considerations in Bilateral, Simultaneous Tendon Injuries of the Upper Extremity

“…Storti et al performed a simultaneous endobutton repair after an acute bilateral FTDBR in a 37-year old male weightlifter. Postoperatively, the patient adhered to 1 week of strict sling immobilization, followed by 2 weeks of interrupted sling use and passive physiotherapy with strength training beginning at 6 weeks 49 .…”

“…To the best of our knowledge, there are only 5 reports describing bilateral, simultaneous FTDBR in the literature [49][50][51][52][53] . Staged interventions, typically 6 weeks apart, were adopted most frequently.…”

Lesões agudas do tendão distal do bíceps: Diagnóstico e tratamento

“…3 Lesões bilaterais, não simultâneas, ocorrem em 8% dos pacientes, sugerindo que alterações prévias são fatores de risco para rupturas do lado não acometido 14 e as simultâneas são descritas como raras (relatos de casos). 15 Aproximadamente 2/3 das rupturas traumáticas aconteceram em pacientes entre 35 e 54 anos (média 46,3 anos) sendo 95,7% do sexo masculino, sem predileção pelo lado dominante. 3 Nas mulheres, em mais de 50% dos casos, as pacientes relataram início insidioso e atraumático dos sintomas com 87% de lesões parciais.…”

“…14 Simultaneous injuries are rare and described in case reports. 15 Approximately two-thirds of the traumatic ruptures occurred in patients between 35 and 54 years old (mean, 46.3 years old). Most (95.7%) subjects were male, and injuries showed no preference for the dominant side.…”

Distal biceps tendon ruptures occur with the almost extended elbow and supinated forearm – an online video analytic study

“…The typical mechanism of injury of the distal biceps tendon has been described as a tension load imposed on the distal biceps tendon when flexing the elbow with a supinated forearm, for example when lifting a heavy object [ 8 – 10 ]. However, much of what is currently known about the mechanism of injury is based on the patients’ anamnestic memories or theoretical models.…”