Distal Biceps Brachii Tendon Rupture Research Articles

Biceps Brachii Distal Tendon Ruptures: Conservative and Surgical Treatment Outcomes

Background. Interest in the study of the distal biceps brachii tendon ruptures in the recent decade has been caused by the development of instrumental diagnostic methods, the new sports disciplines appear and by the technological workplace environment complication. The main concepts of treatment depend on the injury term, the tendon tissue damage area, the patient functional needs and his/her professional activities, the comorbidity index (CCI), so the concepts are divided into two: conservative and surgical.
 The aim of the study to identify the most effective method of treating patients with a biceps brachii distal tendon rupture.
 Methods. The study included 58 patients (all men) with a biceps brachii distal tendon injury. They were divided into groups depending on the concept of treatment: a conservative treatment group 20 (34%) patients and a surgical treatment group 38 (66%). The surgical treatment group was also divided into subgroups according to surgical approaches, reinsertion methods and types of fixation. Patients underwent physical tests (ODriscoll, Ruland, et al.), ultrasound to compare the proximal radio-ulnar space, degree of muscle retraction, lacertus fibrosus involvement, and MRI of the elbow joint. The functional scales VAS, DASH and ASES were used to evaluate the obtained results. The results of instrumental diagnostic methods were evaluated with the L. Perera (2012) and J. Fuente (2018) classifications.
 Results. Evaluation of the results in the groups of surgical (Ns) and conservative (Nc) treatment according to functional scales after 6 (VAS, DASH) and 36 months (ASES) revealed: a decrease in subjective pain score 1 point, a decrease in DASH to 21 and 43 points (statistically significant decrease in both groups p0.001, difference between groups p = 0.005), ASES: 91 and 71 points (dynamics in both groups and difference between groups p 0.001). Minimally invasive approaches compared with open access (nD) showed better functional outcomes according to the DASH scale: nBA vs nD p = 0.006; nMA vs nD p = 0.013 after 6 months, and according to the ASES scale: nBA vs nD p = 0.007; nBA vs nD p= 0.002 after 36 months. An reinsertion methods intragroup analysis revealed the achievement of peak indicators by 6 weeks without complications in the anatomical variant according to the VAS: nBA vs nMA p = 0.264; DASH: nBA vs nMA p = 0.856; ASES nBA vs nMA p = 0.179.
 Conclusion. Comparison within subgroups made it possible to identify the most effective technique combination of minimally invasive access with an anatomical version of intracanal fixation with a cortical button. This technique has shown to have a low risk of postoperative complications.

Results of surgical treatment of distal biceps tendon ruptures

Rupture of the distal biceps tendon is an injury that most often affects men of working age, so the time and quality of rehabilitation is of great socio-economic importance. Conservative treatment in most cases is impractical, as it leads to a significant increase in treatment time and period of incapacity and does not provide a satisfactory recovery of functions. The main problems of surgical treatment of the distal biceps tendon rupture of the shoulder are considered in the article. Today, there are many methods of surgical treatment, including anchor fixation to the hump of the radial bone; fixation of the distal biceps tendon by using an oval-shaped cortical button fixator, etc. The article presents the main methods of treatment, their advantages and disadvantages. The aim of the study. To improve the results of surgical treatment of distal biceps brachii tendon rupture by reducing the recovery time and reducing the proportion of complications using a modified technique of button fixation. Materials and methods. The study was performed by retrospective analysis of the surgical treatment results of 35 patients with fresh rupture of the distal biceps tendon, who were divided into two groups – operated with anchor fixator (n = 15) and cortical button fixator (n = 20). Functional outcomes were assessed by the DASH scale in 3 days, 2 weeks, 6 weeks and 3 months after the intervention; pain intensity was measured by the Visual Analogue Scale (VAS) after 3 days and 2 weeks at rest, after 6 weeks and 3 months – during exercise; the time of surgery was evaluated. Results. There was a statistically significant improvement in the DASH score at 6 weeks and 3 months after intervention in the cortical fixator group (P = 0.008 and P = 0.003, respectively). Cortical fixation surgery required less surgical time (P = 0.0016) and was accompanied by less pain in the early postoperative period (P = 0.0015). Conclusions. Surgical intervention with the proposed method takes less operating time, requires a shorter period of immobilization, is accompanied by lower risks for loss of the retainer stability. Features of the proposed intervention technique avoid heterotopic ossification. Early onset of active movements can accelerate the functional restoration of the injured limb. Surgical intervention with the proposed method requires less surgical access, accompanied by lower pain intensity in the early postoperative period.

Operative Versus Nonoperative Management for Distal Biceps Brachii Tendon Lesions: A Systematic Review and Meta-analysis.

Background:Both nonoperative and operative treatments have been proposed to manage distal biceps brachii tendon avulsions. However, the advantages and disadvantages of these approaches have not been properly quantified.Purpose:To summarize the current literature on both nonoperative and operative approaches for distal biceps brachii tendon ruptures and to quantify results and limitations. The advantages and disadvantages of the different surgical strategies were investigated as well.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic literature search was performed in March 2020 using PubMed Central, Web of Science, Cochrane Library, MEDLINE, Iscrctn.com, clinicaltrials.gov, greylit.org, opengrey.eu, and Scopus literature databases. All human studies evaluating the clinical outcome of nonoperative treatment as well as different surgical techniques were included. The influence of the treatment approach was assessed in terms of the Disabilities of the Arm, Shoulder and Hand (DASH) score and the Mayo Elbow Performance Index; extension, flexion, supination, and pronation range of motion (ROM); and flexion and supination strength ratio between the injured and uninjured arms. Risk of bias and quality of evidence were assessed using the Cochrane guidelines.Results:Of 1275 studies, 53 studies (N = 1380 patients) matched the inclusion criteria. The results of the meta-analysis comparing operative versus nonoperative approaches for distal biceps tendon avulsion showed significant differences in favor of surgery in terms of DASH score (P = .02), Mayo Elbow Performance Index (P < .001), flexion strength (94.7% vs 83.0%, respectively; P < .001), and supination strength (89.2% vs 62.6%, respectively; P < .001). The surgical approach presented 10% heterotopic ossifications, 10% transient sensory nerve injuries, 1.6% transient motor nerve injuries, and a 0.1% rate of persistent motorial disorders. Comparison of the different surgical techniques showed similar results for the fixation methods, whereas the single-incision technique led to a better pronation ROM versus the double-incision approach (81.5° vs 76.1°, respectively; P = .01).Conclusion:The results of this meta-analysis showed the superiority of surgical management over the nonoperative approach for distal biceps tendon detachment, with superior flexion and supination strength and better patient-reported outcomes. The single-incision surgical approach demonstrated a slightly better pronation ROM compared with the double-incision approach, whereas all fixation methods led to similar outcomes.

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

Background:Patients with ruptures of the distal biceps brachii tendon (DBBT) have traditionally been treated via surgical repair, despite limited patient data on nonoperative management.Purpose/Hypothesis:To determine the clinical and functional outcomes for patients with partial and complete DBBT injuries treated nonoperatively or surgically through an anatomic single-incision technique. We hypothesized that there would be no difference in outcomes in patients treated with nonoperative or operative management.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective chart review identified all patients with a partial or complete DBBT injury sustained between 2003 and 2017. Surgically treated patients underwent DBBT repair using an anatomic single-incision technique. Nonoperative management consisted of formal physical therapy. The following clinical outcome measures were included for analysis: American Shoulder and Elbow Surgeons (ASES) score; the Disabilities of the Arm, Shoulder and Hand (DASH) upper extremity patient questionnaire; the Single Assessment Numeric Evaluation (SANE) score; and the 36-Item Short Form Health Survey.Results:A total of 60 patients (mean ± SD age, 47.8 ± 11.5 years; range, 18-70 years) sustained DBBT ruptures (38 complete and 22 partial) during the study period. Of patients with complete DBBT, 34 were treated operatively and 4 nonoperatively; of those with partial DBBT, 11 were treated operatively and 11 nonoperatively. At a mean follow-up of 5.4 ± 4.0 years (range, 0.5-16.6 years), patients with complete DBBT ruptures achieved overall similar improvements with respect to mean ASES pain, ASES function, SANE, and DASH scores, regardless of whether they were treated operatively or nonoperatively. Subjective satisfaction and functional scores were comparable between the groups. Similarly, at a mean follow-up of 4.1 ± 3.8 years (range, 0.5-11.3 years), patients with partial DBBT injuries had improved mean ASES pain, ASES function, SANE, and DASH scores, regardless of operative or nonoperative treatment. Subjective satisfaction and functional scores were comparable between these groups. For those treated surgically, 5 patients (11.1%) sustained a surgical postoperative complication.Conclusion:In our case series, patients were able to achieve satisfactory outcomes regardless of whether they were treated nonoperatively or with an anatomic single-incision approach for complete or partial DBBT ruptures.

The Role of Deadlifts in Distal Biceps Brachii Tendon Ruptures: An Alternative Mechanism Described With YouTube Videos.

Background:The classic injury mechanism of a distal biceps brachii tendon rupture (DBBTR) is eccentric loading to the flexed elbow when the forearm is supinated.Purpose:To determine alternative mechanisms of a DBBTR in powerlifting sports, particularly in deadlift competitions, with the use of YouTube videos.Study Design:Descriptive epidemiology study.Methods:A search on YouTube was performed using the search terms “distal biceps tendon rupture” and “distal biceps tendon injury” combined with “competition,” “deadlift,” and “powerlifting.” The videos underwent an evaluation for accuracy by 3 surgeons according to predetermined criteria. Type of sports activity, participant sex, side of the injury, and arm positions at the time of the injury were recorded.Results:Among the videos reviewed, 35 injuries were found appropriate for an evaluation. All participants were male. The majority of the injuries (n = 25) were observed during the deadlift. Only in 1 deadlift injury were both forearms in supination. In the remaining deadlift injuries (n = 24), all elbows were in extension, with 1 forearm in supination and the other in pronation. Among the deadlift injuries in the mixed-grip position, all ruptures occurred in a supinated extremity: 25% (n = 6) of ruptures occurred on the right side, and 75% (n = 18) of ruptures occurred on the left side; this was a significant difference (P = .014).Conclusion:We described an alternative mechanism for a DBBTR, namely, eccentric loading to an extended elbow when the forearm is supinated during the deadlift. As all the ruptures occurred in a supinated extremity, holding the bar with both forearms in pronation may prevent or decrease the risk of ruptures during the deadlift.

No functional differences in anatomic reconstruction using a one- versus a two-point fixation for distal biceps tendon rupture through a single-incision anterior approach: A prospective randomized trial.

The distal biceps brachii tendon rupture is a rare injury of the musculoskeletal system. Multiple surgical techniques have been described for distal biceps brachii tendon repairs including suture anchors. The aim of this study was to evaluate the outcome of anatomical distal biceps tendon refixation using either one or two suture anchors for reattachment and to determine whether there are significant clinically important differences on the number of anchors used for refixation. A monocentric, randomized controlled trial was conducted, including 16 male patients with a mean age of 47.4years (range, 31.0 to 58.0) in Group 1 (two suture anchors for refixation) and 15 male patients with a mean age of 47.4 (range, 35.0 to 59.0) in Group 2 (one suture anchor for refixation). All surgeries were performed through an anterior approach. The outcome was assessed using the Oxford Elbow Score (OES), the Mayo Elbow Performance Score (MEPS), the Disabilities of the Arm, Shoulder and Hand (DASH) score, the Andrews Carson Score (ACS) and by isokinetic strength measurement for the elbow flexion after six, twelve, 24 and 48 weeks. Radiographic controls were performed after 24 and 48 weeks. No significant differences between both groups were evident at any point during the follow-up period. A continuous improvement in outcome for both groups could be detected, reaching an OES: 46.3 (39.0 to 48.0) vs. 45.5 (30.0 to 48.0), MEPS: 98.0 (85.0 to 100.0) vs. 99.0 (85.0 to 100.0), DASH: 3.1 (0.0 to 16.7) vs. 2.9 (0.0 to 26.7), ACS: 197.0 (175.0 to 200.0) vs. 197.7.

Suture anchor reinsertions of distal biceps rupture: a histologic analysis of a torn tendon and clinical results at short- and long-term follow-up

Distal biceps brachii tendon (DBBT) rupture is a relatively rare injury. Nonsurgical treatment determines 30%-40% power loss of elbow flexion and up to 50% of forearm supination. Therefore, refixation of the DBBT is recommended. The DBBT is exposed to tension and compression loading. It is known that the tendon under compression might develop fibrocartilaginous metaplasia that improves the resistance to compression but reduces the resistance to tension. To test this hypothesis, the present study evaluated the presence of cartilage in DBBT samples. Furthermore, the present study evaluated the clinical and functional outcomes of anatomic reinsertion through suture anchors in a cohort of patients after 1, 3, and 5 years of follow-up. Between 2011 and 2014, 21 patients with DBBT tear underwent a suture anchor reattachment. Histochemical and immunohistochemical analysis of torn samples of DBBT collected at the time of surgical repair were performed to test the presence of cartilage. During the follow-up examination, mobility, elbow radiographs, Mayo Elbow Performance Score, and isokinetic analysis were prospectively evaluated. Fibrocartilage was detected in all tendon samples collected. Two cases of transient paresthesia in the lateral antebrachial cutaneous nerve occurred, but they resolved in 6 weeks. There were novascular deficits, re-ruptures, radioulnar synostoses, or infective complications at follow-up. Three patients reported loss of supination. Mayo Elbow Performance Score showed good and excellent clinical and functional results. Nosignificant differences about strength and fatigue in flexion-supination were recorded between the surgical and contralateral side at 3 and 5 years of follow-up. Arm dominance influenced supination but not flexion. On the basis of our results, we find that the presence of cartilage metaplasia might make the DBBT at higher risk of rupture assuming the compression loading and the hypovascular zone of the tendon. However, concerning the lack of histologicanalysis of the healthy DBBT, its role in tendon pathology remains to be clearly defined. The technique of suture anchor reinsertion by a single incision was shown to be safe, with few complications and good functional results at 5 years of follow-up. No significant differences were reported between the injured and noninjured side in terms of flexion and supination isokinetic analysis, whereas arm dominance had a positive effect on supination.

Partial rupture of the distal biceps brachii tendon: a magnetic resonance imaging analysis

This study is the largest cohort of partial distal biceps brachii tendon ruptures in the literature that was analyzed according to rupture morphology of the long and short tendon heads. Patients with partial distal biceps tendon ruptures were identified using an institutional enterprise data warehouse query at a single institution. A retrospective chart review was performed to record patient demographics, past medical history, and injury mechanism for each patient. Each patient's magnetic resonance images were reviewed to determine injury patterns, specifically the extent of long head (LH) and short head (SH) tendon involvement, and associated injuries. Rupture morphologies were correlated with mechanism of injury, diabetes status, and smoking history. Seventy-seven patients were included in the study. The average age was 52 years (±11.9, range: 23-90 years); 67% were male, with an average body mass index of 28.3 (±4.3). A smoking history was reported in 31.2% of patients and 5.2% were diabetic. The partial ruptures were caused by a traumatic mechanism in 57.1% of cases, 23.4% were atraumatic, and 19.5% had an unknown mechanism. The most common injury morphology was a partial LH rupture with an intact SH tendon (33.8%). Isolated complete ruptures of the LH represented the least common injury morphology. Injury morphology was significantly related to mechanism (P < .01). Traumatic ruptures had a higher percentage of SH involvement compared with the atraumatic group (77.3% vs. 37.7%, respectively). In contrast, atraumatic ruptures involved the LH tendon in 89% of cases, with only 37.7% of cases involving the SH tendon. Patients with a history of smoking were more likely to have an atraumatic mechanism (P = .01). A history of diabetes was unrelated to mechanism (P = .20). Partial ruptures of the distal biceps brachii tendon represent a spectrum of patterns with varying involvement of the LH and SH tendons. Injury morphology was significantly related to mechanism (P < .01). LH tendon involvement was seen in 88.9% of atraumatic cases, whereas SH tendon involvement was seen in 77.3% of traumatic cases. A more comprehensive understanding of partial rupture patterns is critical to further understand the risk factors that may preclude to worse clinical outcomes, and aid in deciding which patients would benefit from operative vs. nonoperative management.

No functional differences in anatomic reconstruction with one vs. two suture anchors after non-simultaneous bilateral distal biceps brachii tendon rupture: a case report and review of the literature

BackgroundSurgical reattachment of the tendon is still the gold standard for ruptures of the distal biceps brachii tendon. Several fixation techniques have been described in the literature, with suture anchors being one of the most common fixation techniques. Currently, there is no data available on how many anchors are required for a safe and stable refixation. In this case report clinical data of a patient with non-simultaneous bilateral distal biceps tendon ruptures treated with a different number of suture anchors for each side (one vs. two) are demonstrated.Case presentationA 47-year-old factory worker suffered a rupture of the distal biceps tendon on both arms following two different occasions. The left side was fixed using a single suture anchor, while refixation on the right side was performed with two anchors.The patient was prospectively followed for one year. Functional outcome was assessed using the Andrews Carson Score (ACS), the Oxford Elbow Score (OES), and the Disabilities of Arm, Shoulder and Hand (DASH) Score after six, twelve, 24 and 48 weeks. Furthermore, an isokinetic strength measurement for flexion strength was performed after 24 and 48 weeks.After 48 weeks the patient presented with excellent functional outcome scores and no follow-up complications. During the follow-up period, no differences in the functional scores nor in the isokinetic flexion strength measurement could be detected. Furthermore, no radiological complications (like heterotopic ossifications) could be detected in the postoperative radiographs after one year.ConclusionsAnatomic reattachment of the distal biceps tendon is a successful operative treatment option for distal biceps tendon ruptures. Suture anchor fixation remains one of the most common techniques, as it allows fast surgery and provides good results with respect to range of motion (ROM) and functional scoring according to the current literature. However, the number of anchors required for a stable fixation remains unclear. As indicated by our presented case, we hypothesize, that there are no significant differences between a one-point or a two-point fixation. In the presented case report, no intraindividual differences between the usage of one versus two suture anchors were evident in the short-term follow-up.

Clinical and sonographic evaluation of Endobutton distal biceps brachii tendon repair: what constitutes normal post-operative appearances?

Distal biceps brachii tendon (DBBT) rupture is an uncommon but functionally significant injury given the loss of supination, flexion strength and pain that often result. Prompt surgical repair is preferred in most patients. Clinicoradiological post-operative follow-up is typically performed to assess DBBT repair integrity and function, frequently using ultrasound, though to date, no studies have described post-operative DBBT repair sonographic appearances. The purpose of this study was to evaluate post-operative DBBT sonographic appearances in the context of Endobutton repair with the following aims:i.Establish typical ultrasound appearances 12months post-surgeryii.Establish the relationship between ultrasound appearances and clinical/functional outcomes. Sixty patients between February 2016 and October 2017 undergoing DBBT repair were prospectively recruited, all undergoing clinical and sonographic assessment 12months post-surgery. Ultrasound data was collected on tendon integrity, tendon calibre and presence of intratendinous calcification, peritendinous fluid and peritendinous soft tissue/scarring. Clinical data was collected on active range of motion (ROM) (flexion, extension, supination, pronation) and strength (flexion and supination). A total of 57/60 patients had intact DBBT repairs identified sonographically and clinically at 12months. DBBT repairs had significantly increased cross-sectional area (mean 260%, 95% CI: 217%, 303%) compared with non-operated DBBT. Ninety-three percent of DBBT repairs were hypoechoic. Thirty percent contained intratendinous calcification. Peritendinous fluid/soft tissue was rarely observed. There was no significant correlation between DBBT calibre and strength/ROM parameters. Normal post-operative sonographic appearances of Endobutton DBBT repair comprise a hypoechoic tendon significantly increased in calibre compared with non-operated tendon ± intratendinous calcification. DBBT repair calibre varies greatly, but is not associated with any significant difference in strength/ROM.

The Radioulnar Distance at the Level of the Radial Tuberosity.

Ruptures of the distal biceps brachii tendon are generally treated operatively due to their loss of supination and flexion force. A mechanical impingement at the insertion of the tendon at the radial tuberosity is discussed to play a role in the etiology of this injury. The aim of this study was to present a detailed, three-dimensional anatomical analysis of the radioulnar space at the radial tuberosity. A total of 166 imprints of the radioulnar space in neutral rotation and pronation from 84 cadaveric specimens of both arms using silicone impression material were produced for this study. Imprints were cut in slices of 3 mm and digitally measured after picture acquisition using a high-resolution digital camera. Distances were grouped into a proximal, central, and distal groups and used for correlation to morphometric data at the elbow (radial head diameter, ulna and radius length) as well as volume calculation. The mean radioulnar distance was 8.8 ± 4.0 mm in neutral rotation and 7.8 ± 3.9 mm in pronation. In pronation, the central zone was the smallest whereas in neutral rotation the proximal zone was the smallest. The volume of the radioulnar space did not reduce significantly during pronation. Little space is provided for the insertion of the distal biceps brachii tendon especially during pronation. This could play a role in the etiology of distal biceps brachii tendon ruptures and should be considered in the fixation after rupture of the tendon. Clin. Anat., 33:661-666, 2020. © 2019 Wiley Periodicals, Inc.

Treatment of the Distal Biceps Brachii Tendon Rupture Using the Three Mini-Incisions Technique: Evaluation through MEPS and DASH

Treatment of the Distal Biceps Brachii Tendon Rupture Using the Three Mini-Incisions Technique: Evaluation through MEPS and DASH

Bye Bye Biceps: Case Report Describing Presentation, Physical Examination, Diagnostic Workup, and Treatment of Acute Distal Biceps Brachii Tendon Rupture

BackgroundRupture of the distal biceps tendon is seen in both the emergency and primary care settings. It most commonly occurs after excessive tension exerted on a flexed forearm. Knowledge of the anatomy, pathophysiology, historical and physical examination findings, as well as the workup, diagnosis, and treatment of distal biceps tendon rupture are essential in achieving good outcomes, as delays in treatment can make surgical repair more challenging and less efficacious. Case ReportA healthy 38-year-old male presented to his primary care physician complaining of right elbow pain that started while lifting an all-terrain vehicle into a truck. On physical examination, the patient had obvious deformity of the distal upper arm, as well as a positive squeeze test. Magnetic resonance imaging confirmed the presence of complete rupture of the distal biceps brachii tendon and the patient was referred to orthopedic surgery for evaluation. Why Should an Emergency Physician Be Aware of This?Prompt diagnosis and referral to orthopedic surgery optimizes outcomes and minimizes complications after distal biceps brachii tendon rupture. Oftentimes, gross examination shows obvious deformity of the distal upper arm, but when swelling, mobility limitations, or patient anatomy hinder this physical examination finding, the diagnosis can be missed. Knowledgeable emergency physicians can perform a physical examination and other diagnostic tests that can confirm or rule out a diagnosis in order to achieve the best outcomes for patients.

Хирургическое лечение пациентов с разрывом дистального сухожилия двуглавой мышцы плеча: методы фиксации и реабилитации. Опыт лечения 20 пациентов

Distal biceps brachii tendon ruptures are relatively uncommon injuries with numerous surgical exposures and methods of fixation offered for repair. The goal of surgical management is to restore the anatomic footprint of the biceps tendon on the radial tuberosity. Distal biceps fixation techniques include the use of bone tunnels in the bicipital tuberosity, tendon fixation with interference screws and cortical button that are competitive with alternative methods of suture anchors and transosseous sutures. Amplification of technical surgical aspects allows for a safer procedure, more aggressive postoperative rehabilitation and reduced recovery period for the elbow joint. Objective The purpose was to present the clinical experience and compare methods of fixation of tendon ruptures in terms of their advantages and disadvantages, implants’ effect on postoperative function recovery in a group of patients followed for three years. Material and methods A retrospective review included 20 patients with distal biceps brachii tendon ruptures that required surgical treatment. Results Positive outcomes were achieved in 19 cases (95 %). Disability period was 33.5 ± 0.5 days in a group of intellectual workers and 45.5 ± 0.71 days in physically active patients or sportsmen. Conclusion The findings showed advantages of combined tendon fixation with cortical button and biodegradable interference screw. The results of treatment were shown to rank more than twice over those achieved with suture anchors and transosseous sutures.

Retrospective Evaluation of Surgical Anatomical Repair of Distal Biceps Brachii Tendon Rupture Using Suture Anchor Fixation.

BackgroundTo date, no consensus has been reached regarding the preferred fixation method to use in the repair of distal biceps brachii tendon rupture. The aim of this study was to clinically and functionally (Mayo Elbow Performance Index, MEPI) assess the upper limb after surgical anatomic reinsertion of the distal biceps brachii tendon with the use of suture anchor fixation method with regard to postoperative time and limb dominance, and to assess postoperative complications.Material/MethodsThe sample comprised 18 males (age 52.09±8.89 years) after surgical anatomical distal biceps brachii reinsertion using suture anchor fixation. A comprehensive clinical and functional evaluation and pain assessment were performed.ResultsIn terms of postoperative complications, an isolated case of surgical site sensory disturbances was noted. Circumferences (p-value 0.21–1.00) and ROM (p-value 0.07–1.00) were similar in the operated and nonoperated limbs. The isometric torque (IT) values of muscles flexing and supinating the forearm were comparable in both limbs (p-value 0.14–0.95), but in patients with the operated dominant limb, the mean IT value was not higher than the value obtained in the nonoperated nondominant one. The MEPI indicated good and excellent results (80.00±15.00–90.00±8.66 points), but a detailed individual analysis showed that reported scores were not in line with objectively measured features.ConclusionsThe results of the comprehensive retrospective evaluation justify the clinical use of suture anchors fixation method in the surgical anatomical reinsertion of a ruptured distal biceps brachii tendon. The assessment of a patient should always report both subjective and objective measures.

Surgical Treatment of Distal Biceps Tendon Ruptures: An Analysis of Complications in 784 Surgical Repairs

Background: Distal biceps brachii tendon ruptures lead to substantial deficits in elbow flexion and supination; surgical repair restores muscle strength and endurance. Purpose: To examine clinical and surgical outcomes for distal biceps tendon repairs in a large, multispecialty, integrated health care system. Study Design: Cohort study; Level of evidence, 3. Methods: Retrospective cohort study of distal biceps tendon repairs performed between January 1, 2008, and December 31, 2015. The repair methods were classified as double-incision approach using bone tunnel–suture fixation or anterior single-incision approach. Anterior single incisions were further classified according to the fixation method: cortical button alone, cortical button and interference screw, or suture anchors alone. Patient demographics, surgeon characteristics, range of motion, and complications were analyzed for all repair types. Results: Of the 784 repairs that met the inclusion criteria, 639 (81.5%) were single-incision approaches. When comparing double-incision and single-incision repairs, there was a significantly higher rate of posterior interosseous nerve palsy (3.4% vs 0.8%, P = .010), heterotopic bone formation (7.6% vs 2.7%, P = .004), and reoperation (8.3% vs 2.3%, P < .001). The most common nerve complication encountered was a lateral antebrachial cutaneous nerve palsy (n = 162), which was significantly more common in the single-incision repairs than in the double-incision repairs (24.4% vs 4.1%, P < .001). When excluding lateral antebrachial cutaneous nerve palsies, there was no significant difference in the overall nerve palsies between single-incision and double-incision (5.8% vs 6.9%, P = .612). The overall rate of tendon rerupture was 1.9% (single incision, 1.6%; double incision, 2.8%; P = .327). The overall rate of postoperative wound infection was 1.5% (single incision, 1.3%; double incision, 2.8%; P = .182). The average time from surgery to release from medical care was 14.4 weeks (single incision, 14 weeks; double incision, 16 weeks; P = .286). Patients treated with cortical button plus interference screw were released significantly sooner than were patients with other single-incision repair types (13.1 ± 8.01 weeks, P = .011). There were no significant differences in rates of motor neurapraxia, infection, rerupture, and reoperation with regard to surgeon’s years of practice, fellowship training, or case volume. Conclusion: The surgical repair of distal biceps tendon ruptures has an overall low rate of serious complications, regardless of approach or technique. However, the double-incision technique has a higher rate of posterior interosseous nerve palsy, heterotopic bone formation, and reoperation rate. Surgeon’s years of practice, fellowship training, and case volume do not affect the rate of major complications.

Good isometric and isokinetic power restoration after distal biceps tendon repair with anchors.

Distal biceps brachii tendon rupture can lead to 30-40% power loss of elbow flexion and up to 50% of forearm supination. Re-fixation of the distal biceps brachii tendon is recommended to warrant an adequate quality of the patient's life. This study reports the isometric and isokinetic results after anchor re-fixation 2.5years after surgery. Between 2007 and 2010, 69 patients with distal biceps brachii tendon tear underwent a suture anchor reattachment. During the follow-up examination, a questionnaire and DASH score were filled in, the circumferences of the arm were measured, range of motion was collected, and different trials were conducted at the BTE Primus RS™ (Baltimore Therapeutic Equipment) on both arms. 49 patients (71%) were reinvestigated with a follow-up of 32months (11-58months). A significant difference was found in the ability of elbow flexion between the affected arm and the opposite side as well as in pronation and supination. In elbow flexion and extension as well as in pronation and supination of the forearm, the strength was significantly diminished. 32months after surgical re-fixation of the distal biceps brachii tendon rupture, strength in all exercises is marginally reduced in comparison to the opposite arm. Re-fixation of the distal biceps brachii tendon is an adequate method to return the range of motion and the strength in the elbow joint to an almost normal level and that gives rise to a high level of patient satisfaction. Level III, case-control study.

Distal Biceps Brachii Tendon Rupture Resulting in Acute Compartment Syndrome

Distal Biceps Brachii Tendon Rupture Resulting in Acute Compartment Syndrome

Distal Biceps Brachii Tendon Rupture Resulting in Acute Compartment Syndrome

Distal biceps brachii tendon rupture is an uncommon injury. Compartment syndrome of the upper arm is rarely described in the literature. The diagnosis of upper arm compartment syndrome requires a high index of suspicion, and emergent surgical treatment with fasciotomy in the acute setting is necessary to avoid devastating neurovascular complications. This article reports a case of acute compartment syndrome of the anterior compartment of the upper arm after a complete rupture of the distal biceps brachii tendon. A healthy 45-year-old man presented with increasing arm pain; paresthesia in the lateral antebrachial cutaneous nerve distribution; and a tense, swollen anterior compartment of his upper arm. Side port catheter absolute pressure measurement was 83 mm Hg with a diastolic blood pressure of 92 mm Hg. The patient underwent an emergent fasciotomy and was found to have a complete rupture of his distal biceps brachii tendon. He subsequently underwent distal biceps tendon repair and delayed primary closure of his incision. Postoperatively, his paresthesia improved and he has no neurological deficit. There is a paucity of case reports describing compartment syndrome after rupture of either the proximal or distal end of the biceps brachii tendon, and none of the reports describe compartment syndrome of the upper arm after rupture of the distal biceps tendon. This article highlights an unusual complication of an uncommon injury and reviews diagnostic and treatment principles for the management of acute compartment syndrome of the upper arm.

Distal biceps brachii tendon rupture: what do we do with these?

Treatment options for distal biceps tendon ruptures are vast, including conservative treatment and many techniques for surgical repair. Surgical repair of distal biceps ruptures is indicated in patients wanting to restore supination strength and endurance. In most cases, direct anatomic repair is indicated, with the two-incision technique modified by Morrey considered the standard. Superior outcomes of surgical repair compared with conservative treatment have been well established. Most contemporary techniques focus on the single-incision approach with types of fixation including suture anchors, cortical buttons and interference screws. Recent literature has focused on descriptions of new techniques along with biomechanical comparisons of these options. Of the one-incision approaches, it is not yet clear which technique is superior. This review provides a discussion of all the most recent data and gives our algorithm for treatment of this injury.