Delayed onset of posterior interosseous nerve palsy after distal biceps tendon repair

Abstract

R upture of the distal biceps brachii is a relatively uncommon injury. Despite its rarity, many treatment methods have been described. Most common is the anatomic restoration of the biceps tendon to the tuberosity. Early reports of iatrogenic radial nerve injury with this technique made surgeons rethink their surgical approach to this problem.4,6,9 In fact, some authors have advocated suturing the biceps brachii to the brachialis, thereby avoiding the risk of nerve injury.4, 9 In 1985, however, Morrey et aLlo found that when the biceps was attached to the brachialis, there was nearly normal strength in elbow flexion but approximately a 50% loss in the strength of forearm supination. This and other studies suggest that the biceps brachii tendon should be reattached anatomically.3, lo, l1 Consequently, since 1961 most surgeons have used the two-incision technique of Boyd-Anderson* in an attempt to achieve anatomic repair while avoiding iatrogenic radial nerve injury. Good results have been reported with this technique. It too, however, has its own complications.5 This case report illustrates yet another unreported complication.