Distal biceps ruptures: open and endoscopic techniques

Abstract

Distal biceps tendon ruptures are relatively rare. Patients are usually middle-aged men involved in heavy labor. Patients usually present with the history of a pop and a proximal migration of the biceps muscle belly. Clinical exam should be sufficient to diagnose a complete rupture. Several specific tests have been described. Ultrasound scanning or MRI can help confirm the diagnosis. Radiographs are not needed to diagnose distal biceps tendon rupture but may show typical findings. Imaging, more specifically the flexion-abduction-supination (FABS) view MRI, is particularly helpful in the case of a partial rupture or chronic rupture of the distal biceps tendon. Results of surgical reinsertion of the distal biceps have been shown to be superior to conservative treatment. Different techniques and approaches have been described with specific advantages and disadvantages. Primary repair of the tendon is preferred. If this is no longer possible in chronic tears, an augmentation can be done using tendon graft. Results of surgical treatment are good in the vast majority of patients. Reruptures are rare but minor complications are common. Major complications may include posterior interosseous nerve palsy or radioulnar synostosis, but the risk of these complications may be decreased by meticulous attention to detail during surgery.

Ultrasonography of Complications in Surgical Repair of the Distal Biceps Brachii Tendon

“…Distal biceps brachii tendon ruptures typically occur in the dominant arm of men between 30 and 60 years who apply an intense extension force to the anterior aspect of the forearm with the elbow in an active flexed position . Various conditions can predispose one to DBBT rupture, such as tendon degeneration and hypovascularity, mechanical conflicts with bony spurs at the radial tuberosity, and use of tobacco or anabolic steroids . The most common pathologic mechanism leading to DBBT rupture is simultaneous powerful contraction of the muscle and passive extension of the elbow.…”

“…26 Various conditions can predispose one to DBBT rupture, such as tendon degeneration and hypovascularity, mechanical conflicts with bony spurs at the radial tuberosity, and use of tobacco or anabolic steroids. 5 The most common pathologic mechanism leading to DBBT rupture is simultaneous powerful contraction of the muscle and passive extension of the elbow. Clinical diagnosis of DBBT rupture is generally easy.…”

“…Although partial tears are usually treated conservatively, complete tears mostly require surgical repair, which provides better functional results . A variety of surgical techniques can be used with varying outcomes . The best technique would achieve optimal anatomic repair and rapid and efficient mobilization as well as lead to fewer complications .…”

“…2 A variety of surgical techniques can be used with varying outcomes. [3][4][5] The best technique would achieve optimal anatomic repair and rapid and efficient mobilization as well as lead to fewer complications. 6 Postoperative complications related to DBBT repair, such as heterotopic ossification, nerve injury, and tendon rerupture, occur in 15% to 40% of patients.…”

Muskelverletzungen des Sportlers

“…Beim medialen ("pronator window") und lateralen Fenster erfolgt die Untersuchung bei rechtwinklig gebeugtem Ellenbogengelenk und supiniertem Unterarm. Dabei [49], stellt die Sonographie trotz Untersucherabhängigkeit eine insgesamt kostengünstige und v. a. im Vergleich zur MRT häufig rasch sowie breit zur Verfügung stehende Modalität dar und sollte daher als First-line-Diagnostik zur Evaluierung von Bizepsläsionen angesehen werden [50].…”