This report described rupture and subsequent repair of the medial head of a bifurcated distal biceps tendon, which had two completely unfused, distinct tendon units and musculotendinous junctions. Rotate your body in the opposite direction of the raised arm until you feel a stretch in your biceps. With the patient in the supine position and the arm. When is a conservative approach best for proximal biceps. David geier is an orthopedic surgeon and sports medicine specialist in charleston, south carolina. Stand facing a wall about 6 inches, or 15 centimeters, away from the wall. Distal biceps tendon ruptures are rare injuries that may have significant functional sequelae. Rupture of the distal biceps tendon at the elbow joint is uncommon and accounts for less than 5% of all biceps tendon ruptures. Anatomic repair of a distal biceps tendon rupture gives consistently excellent subjective and good objec tive results in athletes, particularly for those sports with high strength demands such as weight lifting and body building. Not all pain in the area of the elbow is caused by biceps tendon problems.
More specific instructions and limitations may follow if this is a repair of a chronic distal biceps tendon rupture, or if a tendon graft was used to augment the repair. Azur, repair of acute distal biceps tendon ruptures in operative techniques. Signs and symptoms of a distal biceps tendon rupture. Risk factors men, age 30 years or older, are most likely to tear the distal biceps tendon. Andrew green, md associate professor of orthopaedic.
There are subtle differences between the outcomes of single and. The majority of distal biceps tendon injuries are from complete rupture. It is especially rare to diagnose partial rupture of the distal biceps tendon. Multiple nerve injuries following repair of a distal. A history of tendinitis, overuse, or anabolic steroid abuse may predispose tendons to rupture. He was diagnosed with an acute right distal biceps rupture con. Rupture of the distal biceps tendon in a collegiate.
This injury occurs mainly in middleaged men during heavy work or lifting. In distal biceps tendon ruptures, sonography is a costeffective method that can confirm the clinical indications with good accuracy and can show tendon lesions when the clinical indications are low. Andrew greens office 401 4571533 or the university orthopedics physical therapy department 401 4435000. There is usually some degree of degenerative change within the tendon that predisposes it to rupture and it is seen almost exclusively in males. Distal biceps tendon repair rehabilitation protocol the following protocol should be used as a guideline for rehabilitation progression, but may need to be altered pending the nature and extent of the surgical procedure, healing restraints or patient tolerance. No resisted isotonic bicepintensive exercises elbow flexion or forearm supination. Multiple nerve injuries following repair of a distal biceps. Abstract distal biceps tendon rupture is a fairly uncommon injury but the incidence has risen with the associated increase in recreational activities in the 40 to 60 year old age group. Rehabilitation guidelines for distal bicep tendon repair uw health.
Rehabilitation guidelines for distal bicep tendon repair. It is by no means intended to be a substitute for ones clinical decision making. The biceps is the main muscle on the front of the arm that assists us in bending our elbow and rotating our forearm. Unanticipated loading of the tendon is a common mechanism of injury when the biceps muscle is contracting but the elbow is rapidly straightened, such as when a heavy object is.
The pdf of the article you requested follows this cover page. There are subtle differences between the outcomes of single and modified twoincision. Distal biceps tendon rupture sports medicine today. Distal biceps tendon repair rehabilitation protocol michael b. Rupture of the distal biceps tendon in a collegiate football player. A distal biceps tendon rupture is defined as chronic if it is greater than 4 weeks old.
A rupture of the biceps most often occurs when the elbow is being pulled in to a straightened extended position while it is actively trying to do the opposite. Raise your injured arm out to your side and place the thumb side of your hand against the wall palm down. A distal biceps rupture is rare compared to ruptures where the top of the biceps connects at the. Distal biceps brachii tendon avulsions are relatively uncommon. Nicotine use can affect tendon strength and quality. Rrattachment of the tendon to the radial tuberositv bq means of a pullout suture from lange 1962. The hook test is very reliable for diagnosing ruptures, and magnetic resonance imaging can provide information about the integrity and any intrasubstance degeneration of the tendon. Axial imaging is often used, providing shortaxis images of the tendon, to accurately show the anatomy and disease of the distal biceps tendon.
The distal biceps tendon is injured around the elbow joint. Rupture of the distal biceps tendon in a collegiate football. Distal bicep tendon repair accelerated rehabilitation protocol the intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course for a patient that has undergone a distal biceps tendon repair. Pdf surgical management of acute distal biceps tendon ruptures. Optimal positioning for mri of the distal biceps brachii. Identify the retracted distal end of the biceps tendon and deliver it through the incision. A distal biceps tendon rupture is a tear of the tendon from the forearm bone radius. The combination of the cortical button fixation coupled with an interference screw creates a strong, anatomic repair. The intent of this protocol is to provide the clinician with a guideline of the post operative rehabilitation.
Association between ruptured distal biceps tendon and wild. The distal biceps brachii tendon is an uncommon site for tendon injury, representing 3% of all injuries of the biceps brachii tendon in the literature 1, 2. People frequently develop biceps tendonitis inflammation around the tendon or tendonosis problems with the health of the tendon. There have been many suggestions for optimally imaging the elbow using mri 38. A patients guide to distal biceps rupture the introduction a distal biceps rupture occurs when the tendon attaching the biceps muscle to the elbow is torn from the bone. Scientific article diagnosis, etiology and outcomes of.
Spontaneous rupture of the distal biceps tendon rbt is uncommon, with an estimated prevalence of less than 1 per persons aged 56 to 74 years. Ten cases of distal biceps tendon re rupture were treated between 1988 and 2016. As you struggle, the stress on your biceps increases and the tendon tears away from the bone. Distal bicep tendon repair rehabilitation protocol the intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course for a patient that has undergone a distal biceps tendon repair. Distal biceps tendon rupture midwest orthopaedics at rush. The senior surgeon had previously treated 6 employing an anterior approach, removal of the radial tuberosity, creation of 1. Rehabilitation guidelines for distal bicep tendon repair the elbow is a complex system. Distal biceps tendon rupture is usually caused by a single traumatic event involving flexion against resistance, with the elbow at a right angle. Bilateral distal biceps tendon ruptures newton wellesley.
The complication profile of each surgical approach and fixation technique has not been widely studied in the literature. Four patients patients 1, 6, 8, and 9 developed pain after the initial reattachment. Many patients with a distal biceps rupture will have surgery to repair the torn tendon. Partial rupture of the distal biceps tendon exhibits features similar to that of complete disruption, including acute antecubital pain, weakness of elbow flexion, and forearm supination, and. Distal bicep tendon repair rehabilitation protocol. Distal biceps tendon repair rehabilitation program gundersen. Men, age 30 years or older, are most likely to tear the distal biceps tendon. However, you will notice that your injured arm is much weaker than your uninjured side. In complete rupture of the distal biceps tendon, there is discontinuity with or without retraction.
Published clinical guidelines usually recommend surgical repair for young athletes who require maximum supination strength in daily activities. Repair of distal biceps tendon ruptures in athletes. Savin and others published surgical management of acute distal biceps tendon ruptures find, read and. Distal biceps tendon ruptures of the elbow answers to common questions distal biceps rupture. What to do when you tear your distal biceps tendon. They commonly occur in the dominant arm of middle aged adults.
Rehabilitation of the operated arm, especially the repaired nondominant extremity, should be empha sized. Ruptures tend to occur in the dominant elbow 86% of men 93% in their 40s. Debride the end of the tendon to remove any degenerative or diseased tissue. The results of surgical repair in chronic cases are less sufficient and the surgical technique is more. A distal biceps rupture is rare compared to ruptures where the top of the biceps connects at the shoulder. Distal biceps ruptures occur most commonly in middleaged males and result from eccentric contraction of the biceps tendon. They found that the injury occurs in the dominant extremity 86% of the time and smokers have a 7. Distal biceps tendon repair rehabilitation protocol. Distal biceps tendon ruptures present with an initial tearing sensation accompanied by acute pain. Distal biceps tendon tear is a condition in which the distal biceps tendon i. Identify the lateral antebrachial cutaneous nerve and retract it laterally. In some cases, rupture of the biceps tendon can occur.
A physician who examines the patient will usually be able to make the diagnosis simply by physical exam. Ruptures of the distal tendon account for only 3% of all biceps tendon ruptures. Text epidemiology distal biceps tendon rupture represents about 10% of biceps ruptures. Jul 20, 2006 a distal biceps rupture occurs when the tendon attaching the biceps muscle to the elbow is torn from the bone. Distal biceps tendon ruptures are reported as occurring on the dominant arm of male patients between the third and sixth decades of life. Tendonosis can lead to tendon tears or tendon rupture. Long head of the biceps tendon rupture in professional wrestlers. Distal biceps tendon injuries typically occur in the dominant arm of men in their fourth decade of life. Our case profiles a chronic partial tear of the distal biceps tendon in a pediatric patient.
Discussion a rupture of the distal attachment of the biceps muscle is relatively uncommon. The biceps muscle lies on the front of the upper arm and has two heads. Repair of the biceps tendon end of tendon trimmed sutures placed. Surgical repair restores flexion and supination strength, resulting in good functional outcome. Case report a healthy, righthand dominant 51yearold man sustained injury to his right distal biceps while shoveling dirt. The biceps muscle helps to flex the elbow and rotate the forearm palm up. Rehabilitation guidelines for distal biceps tendon repair. Biceps muscle distal biceps tendon radius bone figure 1. Debate continues regarding optimal treatment as historical reports comparing operative and conservative treatment outcomes suggest acceptable function following non. The biceps tendon connects the biceps muscle to your radius bone, which is one of the forearm bones.
Distal biceps tendon repair using the bicepsbutton and tensionslide technique allows the surgeon to tension and repair the biceps tendon through a single anterior incision. Text provisional diagnosis distal biceps tendon rupture 5. Patient will be fitted with a hinged, limited rom brace lrom preoperatively. Distal biceps tendon protocol brigham and womens hospital. Chronic partial rupture of distal biceps tendon in an. Injuries to the distal biceps tendon can be partial or complete ruptures.
Distal biceps tendon repair rehabilitation protocol michael. Oct 16, 2017 text provisional diagnosis distal biceps tendon rupture 5. At the shoulder there are two tendon attachements, where as at the elbow there is one tendon distal attaching to the radius bone of the forearm. This is usually an injury that occurs with heavy lifting or sports in middleaged men. The muscle attaches to the forearm bone through a tendon, which acts like a rope at the end of the muscle. Additional risk factors for distal biceps tendon tear include. Sonographic diagnosis of distal biceps tendon rupture.
A distal biceps rupture occurs when the tendon attaching the biceps muscle to the elbow is torn from the bone. Uva hand center therapy 415 ray c hunt drive, suite 3200 charlottesville, va 22903 434982hand 4263 biceps tendon repair hep stage 5 12 weeks 6 months now that you are 12 weeks post surgery, you can now use your arm for most functional tasks. Distal biceps tendon ruptures present with an initial tearing sensation. A report of 19 patients treated with anatomic reinsertion and a metaanalysis of 147 cases. The injury usually occurs from a single traumatic event whereby. Surgical repair, followed by a comprehensive rehabilitation program, is indicated to regain full strength and range of motion in both flexion and supination. Distal biceps tendon injuries are common in the middleaged laborer or aging athlete.
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