An update on distal biceps tendon ruptures

Abstract

The incidence of distal biceps ruptures is 1.2/100,000 people per year. It is most commonly seen in men 40--60 yr old involving their dominant arm. The mechanism of injury is the application of an eccentric load to the elbow region. Some report a preceding tendinitis, which speaks to the degenerative changes and decrease in vascularity as contributing factors to the tendon rupture. Nonoperative treatment is an option. However, most younger, healthy, and active patients benefit from early surgical management to regain supination and flexion strength. Chronic and retracted tears also may benefit from surgical fixation. Many new techniques have been described and studied recently. However, they present a different set of challenges to the treating surgeon. With this influx of operative techniques and further study of accepted techniques, new light has been shed on the outcomes and complication profiles of distal biceps tendon repairs. The postoperative course of these repairs also has changed to early motion and earlier return to full activity with increased confidence in fixation techniques.

Clinical and Functional Outcomes After Operative and Nonoperative Treatment of Distal Biceps Brachii Tendon Ruptures in a Consecutive Case Series

“…Furthermore, the high complication rate reported in the current literature associated with operative treatment calls into question the superiority of operative versus nonoperative approaches. 1,6,7,12,14 As such, the optimal treatment for complete and partial DBBT ruptures remains controversial, 1,3 –5,7 –9,12,15,16 with some evidence suggesting favorable outcomes in low-demand or unhealthy patients treated nonoperatively. 4,8 This is supported by the current study wherein patients with complete and partial DBBT ruptures treated operatively and nonoperatively maintained satisfactory clinical and functional outcomes at final follow-up.…”

“…1,6,7,12,14 As such, the optimal treatment for complete and partial DBBT ruptures remains controversial, 1,3 –5,7 –9,12,15,16 with some evidence suggesting favorable outcomes in low-demand or unhealthy patients treated nonoperatively. 4,8 This is supported by the current study wherein patients with complete and partial DBBT ruptures treated operatively and nonoperatively maintained satisfactory clinical and functional outcomes at final follow-up. However, the majority of patients presenting with complete or partial DBBT tears still opt for operative treatment, which may be inherent to a subsequent Popeye deformity and cosmetic reasons, rather than true functional deficit.…”

“…27 While patients who have sustained complete tears may benefit from surgical intervention, low-demand or unhealthy patients may be better suited for nonoperative treatment. 4,8 Thus, when approaching patients with complete tears of the DBBT, particularly in the acute setting, current orthopaedic literature overwhelmingly recommends surgical treatment, despite only limited data being available for a nonoperative approach. 1,3,4,7,9,15,26 Various repair techniques have been developed to match the structural properties of an intact tendon, shedding light on the complexity of managing this unique patient cohort.…”

Progressive Loading in a Strongman Following Distal Biceps Repair: Re-Thinking Load Progression – A Case Report

“…From a rehabilitation perspective, it has been suggested that unrestricted or early range of motion may begin earlier since repair strength is greater than the force of an unweighted forearm in a splint or brace. [19][20][21] Restrictions typically include lifting no more than five pounds and no supination against resistance. At six weeks, gradual strengthening of the upper extremity and aerobic conditioning may begin.…”

Minimally invasive distal biceps tendon repair: a case series

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Distal biceps tendon (DBT) ruptures account for nearly 10% of all biceps tendon ruptures [1][2][3][4], with an incidence of 2.55 per 100,000 patients per year reported in the US [5]. The majority occur in men between 40 and 60 years old, with a greater incidence among manual workers, weight-lifters, and athletes [3,6]. Recent epidemiological studies found a similar prevalence between dominant and non-dominant arms [7].

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