Distal Biceps Brachii Tendon Research Articles

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

Direct and Indirect Methods of High-frequency Ultrasound in Imaging Distal Biceps Brachii Tendon

Objective To explore convenient and effective ultrasound scanning methods and skills for imaging the distal biceps tendon.Methods Totally 80 distal biceps tendons of 40 healthy volunteers were scanned and evaluated with high-frequency ultrasound using the direct and the indirect methods. The scanning time and the subjective comfort scores of each subject were recorded. The imaging clarity of the tendon and its insertion onto the radial tuberosity was evaluated.Results The scanning time of the indirect method was shorter than that of the direct method in all volunteers,male volunteers,and female volunteers,although the differences were not statistically significant(all P> 0.05). The mean scanning time was longer on the left side than on the right side regardless of the scanning method (all P> 0.05). The scanning time in women was significantly shorter than in men when the scan was performed by using indirect method on the left side (t=-2.33,P=0.025),direct method on the right side (t=-3.35,P=0.002),or indirect method on the right side (t=-2.67,P=0.011). However,the scanning time was not significantly different between women and men when using the direct method on the left side (t=-1.27,P=0.213). The subjective comfort score was not significantly different between direct and indirect methods in each group (all P>0.05). However,the subjective comfort score was higher on the right side than on the left side regardless of the methods used. In particular,the subjective comfort scores showed significant difference when using the direct method in all subjects (t=2.32,P=0.026),the indirect method in all subjects (t=3.08,P=0.004),and indirect method in females (t=2.52,P=0.021). The overall subjective comfort score of females was higher than that of males,and the difference was statistically significant when the direct method was used on the right side (t=2.33,P=0.025),although no significant difference was observed for the indirect method on the right side (t=2.00,P=0.053),direct method on the left side (t=0.34,P=0.739),and indirect method on the left side (t=-0.15,P=0.884). The clarity rates of the indirect method for the insertions were 100.0% and 95.0%,which were significantly higher than those of the direct method(right side:100.0% vs. 85.0%,P=0.026;left side:95.0% vs.60.0%,P=0.000). The clarity rates of the main trunk of the tendon showed no significant difference between direct and indirect methods on both sides (right side:100.0% vs.95.0%,P=0.494;left side:92.5% vs.87.5%,P=0.712).Conclusions When high-frequency ultrasound is applied for scanning the distal biceps tendon,the scanning time and the subjective comfort are similar when either the direct method or the indirect method is used. The indirect method has higher clarity in imaging the insertion and may be used as the preferred scanning method,whereas the direct method may serve as a supplementary method.

Efficacy of the "Salento technique", a modified two-incision approach in distal biceps brachii tendon repair. Surgical description and outcomes analysis

IntroductionThe biceps brachii lesion needs to be treated surgically. A modified two incisions technique is proposed and reviewed. Material and Methods: All patients were treated with the same technique. The outcomes were measured with the Quick-DASH Score (QDS), and the Mayo Elbow Performance Score (MEPS). Postoperative complications and distal biceps tendon strength were registered also. ResultsAt one year from the trauma, the QDS and the MEPS were excellent in all patients. 72.97% fully recovered and returned to work after 6 months from the trauma. DiscussionThis technique, thanks to its preservation of anatomical structures, provides great outcomes.

Ultrasound-Guided Steroid Injections for Lateral Antebrachial Cutaneous Nerve Entrapment Within Post-Surgical Scar

A 26-yr-old man experienced a motorbike accident and underwent open reduction and internal fixation of a right humerus and radio-ulnar shaft fractures the next day. Nerve conduction studies were performed 3 mos later because of sensorimotor symptoms in his right upper limb and confirmed axillary, musculocutaneous, and radial neuropathies at the level of the axilla. Because of persistent elbow flexion weakness (manual muscle testing grade 3), surgical excision and advance flap of a longitudinal hypertrophic scar extending from the shoulder to the upper arm were performed. He also eventually underwent removal of the orthopedic implants. He then started rehabilitation focused on range of motion and strengthening exercises of his right upper limb. Function and strength improved gradually, and he returned to work after 1 yr. However, right lateral forearm tightness and numbness were interfering with his daily activities and with sleep. Ultrasonographic (US) tracking of his lateral antebrachial cutaneous nerve (LABCN) showed focal swelling within the forearm scar. Ultrasound-guided hydrodissection of the LABCN with 5 mL of 5% dextrose water was attempted. The symptoms improved by 50% after the procedure but recurred 1 mo later. Therefore, the same procedure was performed a second time 2 mos later, and the symptoms were relieved completely for 1 mo. A third US-guided hydrodissection of the LABCN was performed, but the injectate was changed to triamcinolone 10 mg and 5 mL of lidocaine 1% (Video 1). The patient remained symptom free at the 6-mo follow-up. The LABCN is a terminal branch of musculocutaneous nerve, which is responsible for sensation of the lateral aspect of the forearm. It lies adjacent to the cephalic vein and the distal biceps brachii tendon within the antebrachial region of the elbow, and compression of the LABCN typically presents as pain and dysesthesia along the lateral forearm.1 Common causes of LABCN neuropathy include cephalic venipuncture, distal biceps brachii tendon tears and repair, and pull-up exercises during military training camp.1 This is the first reported case in the literature of LABCN entrapment within a surgical scar. Although electrophysiological studies can determine the level and type of nerve lesion, US nerve tracking may be used to evaluate the cause, severity, and etiology of the entrapment.2 In this case, nerve conduction studies showed slowed sensory nerve conduction velocity and reduced sensory nerve action potential amplitude in the right LABCN. Ultrasound further identified entrapment level and confirmed the cause, which provided a path for potential treatments. Ultrasound-guided nerve hydrodissection is commonly used in pain management although high-quality evidence of its effects is still lacking.3 In this case, the entrapped site was close to the radial artery. Ultrasound guidance prevented unintended injury to the artery. For safety concern, dextrose water is advocated as the primary regimen by more and more physicians for perineural injections. In this case, dextrose was initially used but the effect lasted only for 1 mo. In those whose nerve is entrapped within a scar, corticosteroid may be an alternative if dextrose fails. In conclusion, US is a useful tool to identify morphological changes of peripheral nerves and surrounding structures and is helpful to guide procedures.

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.

A comparative clinical and functional assessment of cortical button versus suture anchor in distal biceps brachii tendon repair

PurposeThe studies comparing the fixation methods being used for the ruptured distal biceps brachii tendon reinsertion show similar outcomes of cortical button and suture anchors usage, however, longer follow-up studies remain necessary. The goal of this study was to compare the clinical and functional three-year outcomes of the cortical button in contrast to the suture anchor fixation. MethodsA retrospective cohort study comprised of 28 males on average 3 years after surgical reinsertion of the distal biceps brachii tendon with the use of a cortical button (Group I, n = 11) or a suture anchor (Group II, n = 17). The outcomes assessed were range of elbow joint and forearm motion (ROM), arm circumferences, visual analogue scale (VAS), Mayo Elbow Performance Index (MEPI), Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) and forearm flexor and supinator muscle torques measured under isometric and isokinetic conditions. ResultsThe comparison between the two studied groups revealed no statistically significant differences in ROM (p = 0.24–1.00), circumferences (p = 0.15–0.50), VAS (p = 0.71), MEPI (p = 0.23), Quick DASH (p = 0.61) or in the obtained muscle torque values (p = 0.07–1.00). However, differences in supination ROM between the surgical and non-surgical side were found in both groups (p = 0.01–0.02), and differences in pronation (p = 0.02) were found in Group II. The muscle torque values obtained in the surgical, dominant limb were lower than those in the nonsurgical, nondominant limb. ConclusionThe comprehensive comparison of three-year outcomes of cortical button versus suture anchor fixations did not favour one fixation method over the other, and the results justify the clinical usage of both methods.

High-resolution ultrasound in the assessment of the distal biceps brachii tendinous complex.

To establish a high-resolution US technique that enables a systematic morphometric examination of the three components that form the distal biceps brachii tendinous complex; the internal bicipital aponeurosis, the distal biceps brachii tendon and the external bicipital aponeurosis (also known as lacertus fibrosus). Fifty cryopreserved cadaver body donor elbows were dissected to obtain morphometric reference values and to establish reliable landmarks for the US examination. Then, a systematic US technique was designed and validated by a one-to-one US/dissection analysis of 11 cryopreserved cadaver body donor elbows. Finally, the systematic US technique was carried out in 44 healthy volunteers and morphometric parameters were compared to those obtained in the first part of the study. Mean dissection reference values: internal bicipital aponeurosis width 39.61mm (10.02 SD) and thickness 0.75mm (0.24 SD), distal biceps brachii tendon width 8.38mm (1.87 SD) and thickness 2.73mm (0.69 SD), external bicipital aponeurosis width 11.17mm (5.84 SD) and thickness 0.85mm (0.28 SD). One-to-one US/dissection correlation was overall good (intraclass correlation coefficient 0.876, p < 0.0001). When comparing volunteer US/dissection measurements, significant differences were encountered in all measures except for internal bicipital aponeurosis width. However, the overall magnitude of such significant differences was <0.7mm. Using the systematics hereby proposed, high-resolution US is reliable for the morphometric assessment of the distal biceps brachii tendinous complex. The external bicipital aponeurosis is morphometrically the most variable structure.

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.

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

Journal of Ultrasound in MedicineVolume 38, Issue 2 p. 499-512 Pictorial Essay Ultrasonography of Complications in Surgical Repair of the Distal Biceps Brachii Tendon Viviane Créteur MD, Corresponding Author Viviane Créteur MD [email protected] [email protected] orcid.org/0000-0002-1495-5276 Department of Radiology, Hospital Erasme, Université Libre of Brussels, University Clinic of Brussels, Brussels, BelgiumAddress correspondence to Viviane Créteur, MD, Department of Radiology, Hospital Erasme, Université Libre of Brussels, University Clinic of Brussels, Route de Lennik 808, B-1070 Brussels, Belgium. E-mail: [email protected], [email protected]Search for more papers by this authorAfarine Madani MD, PhD, Afarine Madani MD, PhD Department of Radiology, Hospital Erasme, Université Libre of Brussels, University Clinic of Brussels, Brussels, BelgiumSearch for more papers by this authorAzadeh Sattari MD, Azadeh Sattari MD Department of Radiology, Hospital Erasme, Université Libre of Brussels, University Clinic of Brussels, Brussels, BelgiumSearch for more papers by this authorWissam El Kazzi MD, Wissam El Kazzi MD Department of Orthopedics and Traumatology, Hospital Erasme, Université Libre of Brussels, University Clinic of Brussels, Brussels, BelgiumSearch for more papers by this authorStefano Bianchi MD, Stefano Bianchi MD orcid.org/0000-0001-5975-6441 Department of Cabinet Imagerie Médicale SA, Geneva, Switzerland Search for more papers by this author Viviane Créteur MD, Corresponding Author Viviane Créteur MD [email protected] [email protected] orcid.org/0000-0002-1495-5276 Department of Radiology, Hospital Erasme, Université Libre of Brussels, University Clinic of Brussels, Brussels, BelgiumAddress correspondence to Viviane Créteur, MD, Department of Radiology, Hospital Erasme, Université Libre of Brussels, University Clinic of Brussels, Route de Lennik 808, B-1070 Brussels, Belgium. E-mail: [email protected], [email protected]Search for more papers by this authorAfarine Madani MD, PhD, Afarine Madani MD, PhD Department of Radiology, Hospital Erasme, Université Libre of Brussels, University Clinic of Brussels, Brussels, BelgiumSearch for more papers by this authorAzadeh Sattari MD, Azadeh Sattari MD Department of Radiology, Hospital Erasme, Université Libre of Brussels, University Clinic of Brussels, Brussels, BelgiumSearch for more papers by this authorWissam El Kazzi MD, Wissam El Kazzi MD Department of Orthopedics and Traumatology, Hospital Erasme, Université Libre of Brussels, University Clinic of Brussels, Brussels, BelgiumSearch for more papers by this authorStefano Bianchi MD, Stefano Bianchi MD orcid.org/0000-0001-5975-6441 Department of Cabinet Imagerie Médicale SA, Geneva, Switzerland Search for more papers by this author First published: 19 July 2018 https://doi.org/10.1002/jum.14707Citations: 6 This pictorial essay presents the ultrasonographic anatomy of native and ruptured distal biceps brachii tendons and their ultrasonographic appearance after surgical repair and in cases of postoperative complications. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume38, Issue2February 2019Pages 499-512 RelatedInformation

Influence of forearm orientation on biceps brachii tendon mechanics and elbow flexor force steadiness

Achilles tendon mechanics influence plantar flexion force steadiness (FS) and balance. In the upper limb, elbow flexor FS is greater in supinated and neutral forearm orientations compared to pronated, with contributions of tendon mechanics remaining unknown in position-dependent FS. This study investigated whether distal biceps brachii (BB) tendon mechanics across supinated, neutral and pronated forearm orientations influence position-dependent FS of the elbow flexors. Eleven males (23 ± 3 years) performed submaximal isometric elbow flexion tasks at low (5, 10% maximal voluntary contraction (MVC)) and high (25, 50, 75% MVC) force levels in supinated, neutral and pronated forearm orientations. Distal BB tendon elongation and CSA were recorded on ultrasound to calculate mechanics of tendon stress, strain and stiffness. Relationships between FS, calculated as coefficient of variation (CV) of force, and tendon mechanics were evaluated with multiple regressions. Supinated and neutral were ∼50% stronger and ∼60% steadier than pronated (p < 0.05). Tendon stress was ∼52% greater in supinated and neutral compared to pronated, tendon strain was ∼36% greater in neutral than pronated (p < 0.05), while tendon stiffness (267.4 ± 78.9 N/mm) did not differ across orientations (p > 0.05). At low forces, CV of force was predicted by MVC (r2: 0.52) in supinated, and MVC and stress in neutral and pronated (r2: 0.65–0.81). At high force levels, CV of force was predicted by MVC and stress in supinated (r2: 0.49), and MVC in neutral (r2: 0.53). Absolute strength and tendon mechanics influence the ability of the BB tendon to distribute forces, and thus are key factors in position-dependent FS.

Ruptura distální šlachy musculus biceps brachii - korelace sonografických a operačních nálezů, výsledky operační terapie

Ruptura distální šlachy musculus biceps brachii - korelace sonografických a operačních nálezů, výsledky operační terapie

Surgical Management of Distal Biceps Tendon Anatomical Reinsertion Complications: Iatrogenic Posterior Interosseous Nerve Palsy.

BackgroundAlthough iatrogenic posterior interosseous nerve (PIN) palsy is an uncommon complication of ruptured distal biceps brachii tendon surgical anatomical reinsertion, it is the most severe complication leading to functional limitation. The present study investigated possible types of PIN palsy as a postoperative complication of anatomical distal biceps tendon reinsertion, and aimed to clinically assess patients at 2 years after its surgical treatment.Material/MethodsThe studied sample comprised 7 male patients diagnosed with an iatrogenic PIN palsies after anatomical reinsertion of the distal biceps tendon, who were referred to the reference center for management of a peripheral nervous system injury. The nerve injury was intraoperatively evaluated. The clinical assessment used the Medical Research Council (MRC) System for motor recovery, and the Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) was performed before the surgical treatment of the PIN injuries and at 2 years postoperatively. In all studied cases, electromyography was performed preoperatively and postoperatively.ResultsThe comparison of the preoperative (x=1.43±0.53) and postoperative (x=4.71±0.49) results of the motor recovery of the PIN demonstrated a statistically significant improvement (p<0.001). Moreover, the results of functional assessments with the use of the Quick DASH questionnaire significantly improved (p<0.001) postoperatively (x=6.14±6.86) compared to the preoperative evaluations (x=54.29±12.05).ConclusionsThe PIN palsies as complications of the surgical anatomical reinsertion of ruptured distal biceps brachii resulted from mechanical nerve compression or direct intraoperative damage. The 2-year outcomes justified the clinical use of surgical management for iatrogenic PIN palsy.

Influence of biceps brachii tendon mechanical properties on elbow flexor force steadiness in young and old males.

Elbow flexor force steadiness (FS) depends on strength and decreases with age. Achilles tendon mechanics effect standing balance and isometric plantarflexion FS. This study investigated the influence of distal biceps brachii (BB) tendon mechanics and elbow flexor strength on age-related decline in FS. Nine young (23±2years) and nine old (77±5years) males performed submaximal isometric elbow flexion tasks at low (2.5%, 5%, 10% maximal voluntary contraction (MVC)) and high (20%, 40%, 60%, 80%MVC) forces in a neutral forearm position. Distal BB tendon elongation and cross-sectional area (CSA) were recorded on ultrasound to calculate mechanics of strain, stress, and stiffness. Coefficient of variation (CV) of force was used to assess relationship of FS to tendon mechanics and strength. Young were 22% stronger and 41% steadier than old (P<.05). Tendon stiffness (170.1±132.9N/mm; 113.0±55.1N/mm) did not differ with age (P>.05). Young had 40% less strain compared to old at 5% MVC, but 42% greater strain at 60% and 80% MVC (P≤.05). Stress was ~18% greater in young at 10%, 20%, and 80% MVC (P≤.05). At low forces, CV of force was predicted by stress (r2 =0.56) in young, and stress and MVC (r2 =0.641) in old. At high forces for both age groups, CV of force was predicted by MVC and stress (r2 =0.39-0.43). Stress and strain is greater in young compared with old males. Because strength influences tendon mechanics and is also associated with FS, absolute strength is a large and modifiable contributor to age-related decline in FS.

Ultrasound classification of traumatic distal biceps brachii tendon injuries

ObjectiveThe present work is aimed at analysing ultrasound findings in patients with distal biceps brachii tendon (DBBT) injuries to assess the sensitivity of ultrasound in detecting the different forms of injury, and to compare ultrasound results with magnetic resonance imaging (MRI) and surgical results.Materials and methodsA total of 120 patients with traumatic DBBT injuries examined between 2011 and 2015 were analysed. We compared ultrasound results with MRI results when surgery was not indicated and with MRI and surgical results when surgery was indicated.ResultsFor major DBBT injuries (complete tears and high-grade partial tears), the concordance study between exploration methods and surgical results found that ultrasound presented a slight statistically significant advantage over MRI (ultrasound: κ = 0.95—very good—95% CI 0.88 to 1.01, MRI: κ = 0.63—good—95% CI 0.42 to 0.84, kappa difference p < 0.01). Minor injuries, in which most tendon fibres remain intact (tendinopathies, elongations and low-grade partial tears), are the most difficult to interpret, as ultrasound and MRI reports disagreed in 12 out of 39 cases and no surgical confirmation could be obtained.ConclusionsBased on present results and previous MRI classifications, we establish a traumatic DBBT injury ultrasound classification. The sensitivity and ultrasound–surgery correlation results in the diagnosis of major DBBT injuries obtained in the present study support the recommendation that ultrasound can be used as a first-line imaging modality to evaluate DBBT injuries.

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.

A Retrospective Evaluation of Anatomical Reinsertion of the Distal Biceps Brachii Tendon Using an ACL TightRope® RT with a Titanium Cortical Button and Ultra High Molecular Weight Polyethylene Suture: A Preliminary Report

A Retrospective Evaluation of Anatomical Reinsertion of the Distal Biceps Brachii Tendon Using an ACL TightRope® RT with a Titanium Cortical Button and Ultra High Molecular Weight Polyethylene Suture: A Preliminary Report

Repeatability of ultrasound in assessment of distal biceps brachii tendon

Objective: Examine the repeatability of ultrasound imaging for capturing cross sectional area (CSA), tendon length and elongation of the distal biceps brachii (dBB) tendon at rest and during submaximal elbow flexion contractions. The secondary purpose was to assess the influence of these architectural measures on tendon mechanics of stress and strain.Methods: Within a testing session and between two days CSA, tendon length and elongation of the dBB were captured with ultrasound. Measures were compared within a session and between days. Pearson’s correlations were performed to determine the intra-class correlation coefficients. Bland and Altman plots were used to identify the agreement between measures as well as the bias in measurements. Paired T-test were performed to ensure the calculated variables did not differ between days. Results: Resting tendon CSA was repeatable and strongly correlated (r = 0.98) within a session and between days; however, modest differences were observed in resting tendon length between days (1.8 mm) although values were correlated (r = 0.98). During submaximal contractions of 10%-80% maximal tendon elongation (r = 0.83) and CSA (r = 0.98) were also repeatable. From the measures of elongation and CSA, the calculated values of tendon strain (r = 0.97) and stress (r = 0.96) were also repeatable.Conclusions: Elongation and CSA of the dBB tendon captured with ultrasound are repeatable between testing sessions. Fromthese measures tendon mechanics can be calculated to define the tendon’s role in upper limb tasks, long-term adaptation anddiagnostics.

Unilateral absence of short head of the biceps brachii in human cadaver: A case study

Anatomical variation in the head of biceps brachii is well documented in various studies in the past. As for our best knowledge with the previous publication, there are so many journals reported with multiple variation including accessory heads of biceps brachii muscle (BBM), but the absence of one head of BBM in unilateral arm is very rare. The proximal tendons of the biceps brachii are commonly involved in pathological processes and are a frequent cause of anterior shoulder pain. Disorders of the distal biceps brachii tendon typically result from partial and complete tears of the muscle. Partial tears are usually characterized by enlargement and abnormal contour of the tendon. The purpose of this study was to find some rare kind of variations in the head of biceps brachii with future enlightenment in its potential effects in the normal functioning of upper limb. In the present study, we found that absence of one head of BBM in unilateral arm of one cadaver during anatomical dissection at Windsor University School of Medicine, Brightons Estate, Cayon, P. O. Box-1621, St. Kitts and Nevis, West Indies. Strong evidence of the absence of one head of BBM may be suggestive of developmental anomaly or physical degeneration of the muscle which may lead to complete or partial dysfunction of the region (Szpinda, et al. 2013). However, further studies can reveal the real case of it.