Distal biceps tendon injuries

Abstract

Distal biceps tendon (DBT) conditions comprise a spectrum of disorders including bicipitoradial bursitis, partial tears, acute and chronic complete tears.In low-demand patients with complete DBT tears, non-operative treatment may be entertained provided the patient understands the potential for residual weakness, particularly in forearm supination.Most acute tears are best treated by primary repair using either single-incision or double-incision techniques with good clinical outcomes.Single-incision techniques may carry a higher risk of nerve-related complications, whereas double-incision techniques have historically been considered to carry a higher risk of heterotopic ossification, particularly if the ulna is exposed.Various fixation techniques, including bone tunnels, cortical buttons, suture anchors, interference screws or a combination seem to provide different fixation strength but similar clinical outcomes.Some chronic tears may be repaired primarily, provided tendon tissue can be identified; alternatively, autograft or allograft reconstruction can be considered, and good outcomes have been reported with both techniques.Cite this article: Alentorn-Geli E, Assenmacher AT, Sanchez-Sotelo J. Distal biceps tendon injuries: a clinically relevant current concepts review. EFORT Open Rev 2016;1:316-324. DOI: 10.1302/2058-5241.1.000053.

The Flexion Initiation Test and an Evidence-Based Diagnostic Algorithm for Distal Biceps Tendon Tears

“… 11 described the hook test for distal biceps tendon ruptures with 100% sensitivity and 100% specificity for complete ruptures. However, some authors have found it clinically difficult to reproduce such “degree of certainty.” 10 Additionally, others have reported that this examination can be challenging to administer because it necessitates palpation of the tendon, which is often painful for the patient with an acute injury. 22…”

“…In this IRB approved study, a retrospective chart review of prospectively collected data was performed for this observational cross-sectional study. One hundred twenty-five consecutive patients who presented to the senior author with a complaint of elbow pain, either acute (≤4 weeks between the injury and first clinic visit) or chronic (>4 weeks), 10 , 16 between April 1, 2017, and April 1, 2020, were included. Patients were excluded if they (1) were younger than 18 years, (2) had a fracture or dislocation, (3) had previous distal biceps surgery, (4) did not have documented results of both physical exam tests (FIT and hook), or (5) did not have confirmation by MRI or surgery of the integrity of the distal biceps tendon.…”

“…1 However, in the acute setting, MRI may cause a delay in patient’s treatment and may add cost to the patient and medical system. 10 Partial-thickness tears are less common, likely underdiagnosed, and high-grade partial thickness tears place patients at risk for rupture completion. 10 …”

“… 10 Partial-thickness tears are less common, likely underdiagnosed, and high-grade partial thickness tears place patients at risk for rupture completion. 10 …”

“… 2 , 13 Furthermore, the hook test has deficiencies in diagnosing partial tears because the maneuver will falsely demonstrate an intact tendon. 10 Thus there is a need for improved physical examination tools to prevent diagnosis delays, improve patient education, and preserve the option for primary surgical repair in the treatment of DBTTs. The flexion initiation test (FIT) was developed as an adjunct diagnostic tool during the physical examination to isolate the biceps brachii at maximal contraction and more accurately assess the integrity of the tendon aimed at improving diagnostic acuity of high-grade partial thickness tears.…”