Distal Biceps Distal Biceps RuptureRupture

Thomas J Kovack DOThomas J Kovack DO

Distal Biceps Distal Biceps RuptureRupture

Normal AnatomyNormal Anatomy

Biceps muscle is responsible for Biceps muscle is responsible for flexing the forearm and supinating flexing the forearm and supinating the forearmthe forearm

InjuryInjury Rupture most common in active men Rupture most common in active men

between ages of 40 and 60 yrs oldbetween ages of 40 and 60 yrs old Also seen in younger men who are Also seen in younger men who are

weighliftersweighlifters Pre-existing degenerative changes Pre-existing degenerative changes

may predispose tendon to rupturemay predispose tendon to rupture Usually single traumatic event Usually single traumatic event

involving flexion against resistanceinvolving flexion against resistance Patients often report painful tearing Patients often report painful tearing

sensation in front of the elbowsensation in front of the elbow

InjuryInjury

InjuryInjury

Patients present with bruising or Patients present with bruising or swelling in the antecubital fossaswelling in the antecubital fossa

Often is a defect where the tendon Often is a defect where the tendon used to insertused to insert

Patients note weakness in elbow Patients note weakness in elbow flexion and forearm supinationflexion and forearm supination

May have pain and cramping of the May have pain and cramping of the biceps musclebiceps muscle

Treatment Treatment

Can be treated non-operativelyCan be treated non-operatively Patient should expect 30% decrease Patient should expect 30% decrease

in overall flexion strength and 40% in overall flexion strength and 40% decrease in supination strength decrease in supination strength ((MorreyMorrey))

Often can have contiuned cramping Often can have contiuned cramping in the biceps musclein the biceps muscle

TreatmentTreatment

Decision for surgery:Decision for surgery:

- Surgery allows anatomic re-Surgery allows anatomic re-attachment of tendonattachment of tendon

- After surgery restoration of strength After surgery restoration of strength approaches normal in flexion and approaches normal in flexion and supinationsupination

SurgerySurgery

Small single incision in front of armSmall single incision in front of arm

Tendon is secured into the radius Tendon is secured into the radius through sutures and anchorsthrough sutures and anchors

Same day surgerySame day surgery

SurgerySurgery

SurgerySurgery

Post-opPost-op

After surgery you are in splint and After surgery you are in splint and sling for first weeksling for first week

Weeks 1-4 are spent in Bledsoe Weeks 1-4 are spent in Bledsoe bracebrace

Post-opPost-op

Weeks 4 -12 spent working on ROM Weeks 4 -12 spent working on ROM as tolerated but no liftingas tolerated but no lifting

At 3 months can begin biceps curlsAt 3 months can begin biceps curls

Risks of SurgeryRisks of Surgery

Nerve InjuryNerve Injury Arterial InjuryArterial Injury InfectionInfection Loss of motionLoss of motion Heterotopic ossificationHeterotopic ossification Risks of anesthesia Risks of anesthesia