Distal Biceps Tendon Injuries: Treatment of Partial and Complete Tears

Abstract

Distal biceps ruptures predominantly affect males in their third to fifth decade of life who are involved in heavy lifting or manual labor activities. This includes athletes from those in the professional ranks to weekend warriors. They commonly describe a tearing event with the elbow in flexion and undergoing an eccentric load. The hook test is highly sensitive and specific in diagnosis. In the setting of partial-thickness tears, the hook test can be negative but can elicit pain. Magnetic resonance imaging is the imaging modality of choice to determine partial vs full-thickness tears and the degree of proximal migration of the tendon stump. Operative intervention is recommended for most athletes and people in need of elbow flexion and supination strength and endurance. Operative repair techniques have improved and now allow early range of motion and strengthening for return of patients to their sports or activities of choice with good clinical outcomes reported using multiple techniques. The authors preferred technique is the use of a suture button and interference screw construct that has been validated in both biomechanical testing and clinical outcomes studies.