1
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Ribas LHBV, Schor B, Filho GDRM, Belangero PS. Acute Distal Biceps Tendon Injury: Diagnosis and Treatment. Rev Bras Ortop 2023; 58:e689-e697. [PMID: 37908533 PMCID: PMC10615608 DOI: 10.1055/s-0043-1771488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 04/12/2023] [Indexed: 11/02/2023] Open
Abstract
Acute distal biceps injuries clinically present with sudden pain and acute loss of flexion and supination strength. The main injury mechanism occurs during the eccentric load of the biceps. The hook test is the most significant examination test, presenting the highest sensibility and specificity for this lesion. Magnetic resonance imaging, the gold standard imaging test, can provide information regarding integrity and identify partial and/or complete tears. The surgical treatment uses an anterior or double approach and several reattachment techniques. Although there is no clinical evidence to recommend one fixation method over the other, biomechanical studies show that the cortical button resists better to failure. Although surgical treatment led to an 89% rate of return to work in 14 weeks, the recovery of high sports performance occurred in 1 year, with unsustainable outcomes.
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Affiliation(s)
- Luiz Henrique Boraschi Vieira Ribas
- Aluno do Programa de Pós-Graduação do Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
- Médico ortopedista, especialista em Ombro e Cotovelo, Instituto Vita, São Paulo, SP, Brasil
| | - Breno Schor
- Médico ortopedista, especialista em Ombro e Cotovelo, Instituto Vita, São Paulo, SP, Brasil
| | - Geraldo da Rocha Motta Filho
- Médico ortopedista, especialista em Ombro e Cotovelo, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
| | - Paulo Santoro Belangero
- Cirurgião ortopçdico, Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
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2
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Tagliero AJ, Till SE, Wilbur RR, Song BM, Reinholz AK, Johnson AC, Sanchez-Sotelo J, Barlow JD, Camp CL. Management of Partial-Thickness Tears of the Distal Bicep Tendon: Evaluation of 111 Patients With 10-Year Follow-up. Orthop J Sports Med 2023; 11:23259671231169202. [PMID: 37342555 PMCID: PMC10278407 DOI: 10.1177/23259671231169202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/13/2023] [Indexed: 06/23/2023] Open
Abstract
Background There is a paucity of research on the management of partial-thickness tears of the distal bicep tendon, and even less is known about the long-term outcomes of this condition. Purpose To identify patients with partial-thickness distal bicep tendon tears and determine (1) patient characteristics and treatment strategies, (2) long-term outcomes, and (3) any identifiable risk factors for progression to surgery or complete tear. Study Design Case-control study; Level of evidence, 3. Methods A fellowship-trained musculoskeletal radiologist identified patients diagnosed with a partial-thickness distal bicep tendon tear on magnetic resonance imaging between 1996 and 2016. Medical records were reviewed to confirm the diagnosis and record study details. Multivariate logistic regression models were created using baseline characteristics, injury details, and physical examination findings to predict operative intervention. Results In total, 111 patients met inclusion criteria (54 treated operatively, 57 treated nonoperatively), with 53% of tears in the nondominant arm and a mean follow-up time after surgery of 9.7 ± 6.5 years. Only 5% of patients progressed to full-thickness tears during the study period, at a mean of 35 months after the initial diagnosis. Patients who were nonoperatively treated were less likely to miss time from work (12% vs 61%; P < .001) and missed fewer days (30 vs 97 days; P < .016) than those treated surgically. Multivariate regression analyses demonstrated increased risk of progression to surgery with older age at initial consult (unit odds ratio [OR], 1.1), tenderness to palpation (OR, 7.5), and supination weakness (OR, 24.8). Supination weakness at initial consult was a statistically significant predictor for surgical intervention (OR, 24.8; P = .001). Conclusion Clinical outcomes were favorable for patients regardless of treatment strategy. Approximately 50% of patients were treated surgically; patients with supination weakness were 24 times more likely to undergo surgery than those without. Progression to full-thickness tear was a relatively uncommon reason for surgical intervention, with only 5% of patients progressing to full-thickness tears during the study period and the majority occurring within 3 months of initial diagnosis.
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Affiliation(s)
- Adam J. Tagliero
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Sara E. Till
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan R. Wilbur
- Washington University Orthopedics, St. Louis, Missouri, USA
| | - Bryant M. Song
- Washington University Orthopedics, St. Louis, Missouri, USA
| | - Anna K. Reinholz
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Adam C. Johnson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Jonathan D. Barlow
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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3
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Schmidt GJ, Fischer JP, Crosby NE, Hoyer RW. Clinical Outcomes of Surgical Repair for Partial Distal Biceps Tendon Tears. J Hand Surg Am 2023:S0363-5023(22)00717-1. [PMID: 36604201 DOI: 10.1016/j.jhsa.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/13/2022] [Accepted: 11/25/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE The purpose of this study was to describe the outcomes of patients treated with surgical repair of partial tears of the distal biceps tendon. METHODS The study was a retrospective review of repairs of partial tears of the distal biceps tendon performed by multiple surgeons from January 1, 2015 to October 15, 2020. Inclusion criteria consisted of preoperative magnetic resonance imaging indicative of distal biceps pathology without a complete tear and surgical treatment with intraoperative confirmation of a partial tear. The presence of preceding trauma, duration of symptoms, and postoperative complications were documented. Patients were contacted for outcome assessment using the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and Patient-Reported Elbow Evaluation outcome measures. Clinical outcomes were obtained from 56 of 74 (76%) eligible patients with an average follow-up of 46 months (range: 15-85 months). RESULTS After surgery, the median QuickDASH was 2.3 (interquartile range, 0-9.7), and the median Patient-Reported Elbow Evaluation score was 1 (interquartile range, 0-12). Postoperative QuickDASH scores were significantly lower than the preoperative scores. Known traumas preceding the symptoms and duration of symptoms before surgery were not significantly associated with the outcome. Of all eligible patients, 30 complications were reported in 25 (34%) patients and included 2 reruptures, 2 cases of heterotopic ossification, 1 deep infection, 1 case of implant irritation, 21 neuropraxias, and 3 hematomas. Five (7%) patients underwent 6 reoperations including 1 revision for a rerupture, 1 irrigation and debridement, 2 heterotopic ossification excisions, 1 hematoma evacuation, and 1 implant removal. CONCLUSIONS The results suggest that the repair of partial distal biceps tendon tears is a viable treatment option with significant improvement in QuickDASH. There was no significant relationship between the postoperative outcome and duration of symptoms or known traumas preceding the symptoms. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Gregory J Schmidt
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN.
| | - James P Fischer
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
| | | | - Reed W Hoyer
- Indiana Hand to Shoulder Center, Indianapolis, IN
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4
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Boyle AB, George CM, MacLean SBM. Anatomic factors associated with partial distal biceps tendon tears: a comparative control study. J Shoulder Elbow Surg 2022; 31:1224-1230. [PMID: 35247572 DOI: 10.1016/j.jse.2022.01.149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/17/2022] [Accepted: 01/23/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is minimal literature on the anatomic factors associated with partial distal biceps tendon (DBT) tears. It has been proposed that a larger radial tuberosity size-and, therefore, a smaller radioulnar space during pronation-may cause mechanical impingement of the DBT predisposing to tears. We sought to investigate the anatomic factors that may be associated with partial DBT tears by retrospectively reviewing the DBT anatomy using 3-T magnetic resonance imaging (MRI) scans of elbows with partial DBT tears and a comparison group of normal elbows. METHODS Two independent observers retrospectively reviewed 3-T MRI scans of elbows with partial DBT tears and elbows without visible pathology. Basic demographic data were collected, and measurements of radial tuberosity length, radial tuberosity thickness, radioulnar space, and radial tuberosity-ulnar space were made using simultaneous tracker lines and a standardized technique. The ratio of radial tuberosity thickness to radial diameter and the ratio of radioulnar space to radial tuberosity-ulnar space were calculated. The presence or absence of enthesophytes and the presence of a single DBT vs. double DBTs were noted. RESULTS This study included twenty-six 3-T MRI scans of 26 elbows with partial DBT tears and thirty 3-T MRI scans of 30 elbows without pathology. Basic demographic data were comparable between the 2 groups. The tear group showed statistically significantly larger mean measurements for radial tuberosity length (24.3 mm vs. 21.3 mm, P = .002) and radial tuberosity thickness (5.5 mm vs. 3.7 mm, P < .0001). The tear group also showed statistically significantly smaller measurements for radioulnar space (8.2 mm vs. 10.0 mm, P = .010) and radial tuberosity-ulnar space (7.2 mm vs. 9.1 mm, P = .013). The ratio of radial tuberosity thickness to radial diameter was statistically significantly larger in the tear group (0.389 vs. 0.267, P < .0001). There was a statistically significant positive correlation between partial DBT tears and the presence of enthesophytes (P = .007), as well as between partial DBT tears and the presence of 2 discrete DBTs rather than a single tendon or 2 DBTs that interdigitated prior to insertion (P < .0001). CONCLUSION Larger radial tuberosities and smaller radioulnar and radial tuberosity-ulnar spaces are associated with partial DBT tears. Larger tuberosities and a smaller functional space for the DBT may lead to chronic impingement, tendon delamination, and consequent weakness, which ultimately lead to tears. Enthesophytes may be associated with tears for the same reason. The presence of 2 discrete DBTs that do not interdigitate prior to insertion is also associated with partial tears. This study will help clinicians understand the pathogenesis of partial DBT tears.
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Affiliation(s)
| | - Cherrelle M George
- Department of Orthopaedic Surgery, Tauranga Hospital, Bay of Plenty, New Zealand
| | - Simon B M MacLean
- Department of Orthopaedic Surgery, Tauranga Hospital, Bay of Plenty, New Zealand
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5
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Rao AJ, Scarola GT, Rowe TM, Yeatts NC, Macknet DM, Ford SE, Hong IS, Gaston RG, Saltzman BM, Hamid N, Connor PM. Distal Biceps Repairs in Females: A Large Single-Center Case Series. HSS J 2022; 18:264-270. [PMID: 35645642 PMCID: PMC9096998 DOI: 10.1177/15563316211009855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/12/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Distal biceps repair is a commonly reported procedure in male patients, with reliable outcomes and minimal long-term complications. Information on female patients, however, is limited, and variation in presentation and clinical outcomes is unknown. QUESTIONS/PURPOSE We sought to report on the presentation, treatment algorithm, and outcomes of a case series of female patients with distal biceps pathology. METHODS A retrospective evaluation was performed from a large, single specialty orthopedic group from 2005 to 2017. Inclusion criteria were surgical treatment of the distal biceps in female patients, with minimum 3 months of follow-up. The primary outcome variable was the Mayo Elbow Performance Score (MEPS). RESULTS Of 26 patients who met inclusion criteria, 18 (70%) were available for follow-up with patient-reported outcomes. Median age at time of injury was 56.1 years; 46.2% of patients presented with a complete tear of the distal biceps, and the remaining 53.8% presented with a partial tear that failed nonoperative treatment. Six patients had lateral antebrachial cutaneous neuritis in early follow-up, which ultimately resolved. Median MEPS score was 100 (interquartile range: 20). CONCLUSION This study represents the largest case series to date describing the presentation, treatment, and outcomes of female patients with distal biceps repair. Women tend to be older than men, have more insidious onset of pain, present with partial tearing, and may benefit from nonoperative treatment. Ultimately, based on this case series we believe distal biceps repair in female patients is a successful operation with minimal complications and high patient satisfaction.
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Affiliation(s)
- Allison J. Rao
- OrthoCarolina Sports Medicine Center,
Charlotte, NC, USA
| | | | | | - Nicholas C. Yeatts
- OrthoCarolina Sports Medicine Center,
Charlotte, NC, USA,Musculoskeletal Institute, Atrium
Health, Charlotte, NC, USA
| | | | - Samuel E. Ford
- Department of Orthopedics, Atrium
Health, Charlotte, NC, USA
| | - Ian S. Hong
- OrthoCarolina Sports Medicine Center,
Charlotte, NC, USA,Musculoskeletal Institute, Atrium
Health, Charlotte, NC, USA
| | - R. Glenn Gaston
- Musculoskeletal Institute, Atrium
Health, Charlotte, NC, USA,OrthoCarolina Hand Center, Charlotte,
NC, USA
| | - Bryan M. Saltzman
- OrthoCarolina Sports Medicine Center,
Charlotte, NC, USA,Musculoskeletal Institute, Atrium
Health, Charlotte, NC, USA,Bryan M. Saltzman, MD, OrthoCarolina Sports
Medicine Center, 1915 Randolph Rd, Charlotte, NC 28207, USA.
| | - Nady Hamid
- Musculoskeletal Institute, Atrium
Health, Charlotte, NC, USA,OrthoCarolina Shoulder & Elbow
Center, Charlotte, NC, USA
| | - Patrick M. Connor
- OrthoCarolina Sports Medicine Center,
Charlotte, NC, USA,Musculoskeletal Institute, Atrium
Health, Charlotte, NC, USA
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6
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Hamoodi Z, Winton J, Bhalaik V. Partial tear of the distal biceps tendon: Current concepts. J Orthop 2022; 32:18-24. [DOI: 10.1016/j.jor.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 05/01/2022] [Indexed: 02/04/2023] Open
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7
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Albishi W, Agenor A, Lam JJ, Elmaraghy A. Distal Biceps Tendon Tears: Diagnosis and Treatment Algorithm. JBJS Rev 2021; 9:01874474-202107000-00002. [PMID: 34260471 DOI: 10.2106/jbjs.rvw.20.00151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Distal biceps tendon (DBT) tears occur most commonly in middle-aged men after a sudden, forced eccentric contraction of the flexed elbow. » An understanding of the multiple risk factors, mechanisms, and pathophysiological causes is essential for proper and timely diagnosis. » High clinical suspicion and routine physical examination with appropriate special examination tests, including the hook test, the passive forearm pronation test, the biceps crease interval test, and the bicipital aponeurosis flex test, can help with rapid and accurate diagnosis and guide appropriate and timely management. » Treatment for DBT tears depends on the extent (complete versus incomplete) and timing (acute versus chronic) of the injury, and options include nonoperative management, repair, and reconstruction with or without repair of the bicipital aponeurosis.
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Affiliation(s)
- Waleed Albishi
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Aouod Agenor
- Department of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jason J Lam
- Department of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Amr Elmaraghy
- Department of Orthopaedic Surgery, Unity Health, St. Joseph's Health Centre, Toronto, Ontario, Canada
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8
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Kheiran A, Pandey A, Pandey R. Common tendinopathies around the elbow; what does current evidence say? J Clin Orthop Trauma 2021; 19:216-223. [PMID: 34150494 PMCID: PMC8190485 DOI: 10.1016/j.jcot.2021.05.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/15/2021] [Accepted: 05/16/2021] [Indexed: 01/21/2023] Open
Abstract
Tendinopathies are common causes of pain around the elbow resulting in significant functional impairment in athletes or the working-age population. Patients complain of a gradual onset pain with or without any specific trauma. Tissue histology shows chronic fibroblast and vascular proliferation, with a disorganized collagen pattern and absence of inflammatory mediators. Currently, numerous treatment options are described, but many of these are only supported by a heterogenous evidence base. Thus, management guidelines are difficult to define. Surgery is mostly indicated in selected cases that have failed non-operative management. This article reviews the pathophysiology and natural history of lateral and medial elbow tendinopathies, as well as distal biceps and triceps tendinopathies, and their current treatment options.
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Affiliation(s)
- Amin Kheiran
- Shoulder & Elbow Unit, University Hospitals of Leicester, Leicester, UK
| | - Aditi Pandey
- University College of London Hospital, London, UK
| | - Radhakant Pandey
- Shoulder & Elbow Unit, University Hospitals of Leicester, Leicester, UK,Corresponding author. University Hospitals of Leicester Leicester, LE5 4PW, UK
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9
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Tomizuka Y, Schmidt CC, Davidson AJ, Spicer CS, Smolinski MP, Mauro RJ, Delserro SM, Szabo LH, Smolinski PJ, Miller MC. Partial Distal Biceps Avulsion Results in a Significant Loss of Supination Force. J Bone Joint Surg Am 2021; 103:812-819. [PMID: 33497074 DOI: 10.2106/jbjs.20.00445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Partial avulsions of the short and/or long head of the distal biceps tendon cause pain and loss of strength. The goal of the present study was to quantify the loss of supination and flexion strength following a series of surgical releases designed to simulate partial and complete short and long head traumatic avulsions. METHODS Mechanical testing was performed to measure supination moment arms and flexion force efficiency on 18 adult fresh-frozen specimens in pronation, neutral, and supination. The distal biceps footprint length was divided into 4 equal segments. In 9 specimens (the distal-first group), the tendon was partially cut starting distally by releasing 25%, 50%, and 75% of the insertion site. In the other 9 specimens (the proximal-first group), the releases started proximally. Mechanical testing was performed before and after each release. RESULTS Significant decreases in the supination moment arm occurred after a 75% release in the distal-first release group; the decrease was 24% in pronation (p = 0.003) and 10% in neutral (p = 0.043). No significant differences in the supination moment arm (p ≥ 0.079) or in flexion force efficiency (p ≥ 0.058) occurred in the proximal-first group. CONCLUSIONS A simulated complete short head avulsion significantly decreased the supination moment arm and therefore supination strength. CLINICAL RELEVANCE A mechanical case can be made for repair of partial distal biceps tendon avulsions when the rupture involves ≥75% of the distal insertion site.
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Affiliation(s)
- Yoshiaki Tomizuka
- Department of Orthopaedic Surgery, Nihon University School of Medicine, Tokyo, Japan.,Shoulder and Elbow Mechanical Research Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Christopher C Schmidt
- Shoulder and Elbow Mechanical Research Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Anthony J Davidson
- Shoulder and Elbow Mechanical Research Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Christopher S Spicer
- Shoulder and Elbow Mechanical Research Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael P Smolinski
- Shoulder and Elbow Mechanical Research Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ryan J Mauro
- Shoulder and Elbow Mechanical Research Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sean M Delserro
- Shoulder and Elbow Mechanical Research Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Linsey H Szabo
- Shoulder and Elbow Mechanical Research Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Patrick J Smolinski
- Shoulder and Elbow Mechanical Research Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mark Carl Miller
- Shoulder and Elbow Mechanical Research Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, Pennsylvania
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10
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Wörner E, van Oost I, Eygendaal D, The B. Higher failure rate of suture anchors in partial distal biceps tendon ruptures in comparison with Endobutton fixation. JSES Int 2021; 5:821-826. [PMID: 34223437 PMCID: PMC8245990 DOI: 10.1016/j.jseint.2021.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Little is known about the preferred repair technique of partial tears of the distal biceps tendon. In this study, suture anchors were compared with the Endobutton technique for repair of partial distal biceps tendon ruptures, especially regarding failure rate. Methods A total of 59 patients with 62 partial distal biceps ruptures underwent surgical treatment between 2008 and 2019. Repair of the partially ruptured distal biceps tendon was performed using suture anchors (n = 21) or an Endobutton (n = 41). Postoperative evaluation consisted of integrity and physical examination of the distal biceps tendon, range of motion, stability, neurologic status, and radiographs in AP view and lateral direction of the elbow. Results At a median follow-up of 14 (1-82) months in all patients, a total of 5 patients had a rerupture of the reconstructed distal biceps tendon (8.1%). A significant higher rerupture rate was seen in the suture anchor group (n = 4) than in the Endobutton group (n = 1) (P = .04). The other outcome measures were similar between groups. Other than rerupture rate, there were complications in 21 patients (34%). The major symptomatic complication was attributed to lateral antebrachial cutaneous nerve neuropraxia (n = 8, 15%). Heterotopic ossifications were seen in 12 patients (34%), and ossifications were symptomatic in 4 of these patients (33%). Conclusion A significantly higher failure rate was seen after repair of a partial distal biceps rupture using suture anchors than by using an Endobutton technique. Overall, both techniques were accompanied with complications, in particular, lateral antebrachial cutaneous nerve neuropraxia neuropraxia and the formation of heterotopic ossifications, though clinically less relevant than a rerupture.
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Affiliation(s)
- Elisabeth Wörner
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands.,Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Iris van Oost
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Denise Eygendaal
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands.,Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Bertram The
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
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11
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Iqbal K, Leung B, Phadnis J. Distal biceps short head tears: repair, reconstruction, and systematic review. J Shoulder Elbow Surg 2020; 29:2353-2363. [PMID: 32778325 DOI: 10.1016/j.jse.2020.04.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/25/2020] [Accepted: 04/28/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Isolated short head tears of the distal biceps are uncommon and often underappreciated. The aim of this study was to describe the presenting features and management of acute and chronic short head ruptures treated at our unit and in the published literature. METHODS Six short head ruptures in 5 patients are described. The clinical and radiographic findings, operative techniques, and postoperative outcomes are reported for all patients. A systematic review of the existing literature was also performed. RESULTS All patients presented with pain and weakness following an acute traumatic event. One patient presented with bilateral tears 3 years apart. Four of the ruptures underwent acute repair. Two ruptures presented chronically with retracted short head tears and were treated with allograft reconstruction of the short head. Preoperative magnetic resonance imaging findings demonstrated retraction of the short head affecting only 1 muscle belly, and in all patients the hook test was intact. All patients reported excellent functional outcome scores with no postoperative complications. The systematic review identified 9 previously reported cases, of which 8 were treated surgically with a successful outcome. Detailed analysis of these cases demonstrated clinical findings consistent with our cases, and these are outlined in depth in the article. DISCUSSION/CONCLUSIONS Isolated short head ruptures are a rare and distinct form of distal biceps tear that present with consistent clinical findings that can aid in diagnosis. They present acutely, have a poor natural history akin to complete tears, and have good outcomes with acute and delayed reconstruction.
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Affiliation(s)
- Karim Iqbal
- Trauma and Orthopaedics Department, Brighton and Sussex University Hospitals NHS, Brighton, UK.
| | - Brook Leung
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Joideep Phadnis
- Trauma and Orthopaedics Department, Brighton and Sussex University Hospitals NHS, Brighton, UK
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12
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Nicolay RW, Lawton CD, Selley RS, Johnson DJ, Vassa RR, Prescott AE, Omar IM, Marra G. Partial rupture of the distal biceps brachii tendon: a magnetic resonance imaging analysis. J Shoulder Elbow Surg 2020; 29:1859-1868. [PMID: 32815807 DOI: 10.1016/j.jse.2020.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 04/04/2020] [Accepted: 04/12/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSION 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.
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Affiliation(s)
- Richard W Nicolay
- Department of Orthopedic Surgery, Northwestern Memorial Hospital, Chicago, IL, USA.
| | - Cort D Lawton
- Department of Orthopedic Surgery, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Ryan S Selley
- Department of Orthopedic Surgery, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Daniel J Johnson
- Department of Orthopedic Surgery, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Ravi R Vassa
- Department of Radiology, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Adam E Prescott
- Department of Radiation Oncology, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Imran M Omar
- Department of Radiology, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Guido Marra
- Department of Orthopedic Surgery, Northwestern Memorial Hospital, Chicago, IL, USA
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13
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Return to work following a distal biceps repair: a systematic review of the literature. J Shoulder Elbow Surg 2020; 29:1002-1009. [PMID: 32147339 DOI: 10.1016/j.jse.2019.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 12/07/2019] [Accepted: 12/10/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Among an active aging population, distal biceps tendon ruptures are becoming increasingly common. Typically, they are the result of an acute heavy eccentric load being placed on an already contracted muscle, and surgery is the gold standard treatment for optimal clinical and functional outcomes. Although improved strength has been shown after operative repair, there is little evidence available regarding a timeframe for return to work-related activity. The purpose of this study was to conduct a systematic review of the literature to provide guidance for return to work after a distal biceps repair. METHODS The authors searched online databases (EMBASE, MEDLINE) from inception until October 11, 2018, for literature pertaining to functional outcomes after distal biceps repair. Study inclusion and exclusion criteria were established a priori and applied in duplicate independently by 2 reviewers. RESULTS Of the 480 initial studies, 40 papers satisfied full text inclusion criteria (19 case control studies, 12 retrospective reviews, 9 prospective reviews). A total of 1270 patients with 1280 distal bicep ruptures were included in the study. The mean age of patients was 45.38 years, and 97% (n = 1067) of reported patients were male. The mean follow-up time was 30 months (range, 6-84 months). After distal biceps repair, 1128 (89%) of patients were able to fully return to work without any modification of duties. Time to return to work was reported in 17 of the included studies with a mean of 14.37 ± 0.52 weeks. DISCUSSION The average time to return to work after distal biceps repair in the literature was just beyond 14 weeks. Patients and employers may be given a range between 3 and 4 months, with variation dependent on job demands. Further studies are needed to establish whether the surgical approach or repair technique has any impact on time to return to work.
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Faict S, Van de Meulebroucke B, Van Royen K, Bleys D, Rezaie W, Middernacht B. Distal biceps section and reinsertion for chronic distal biceps tendinopathy. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1405-1409. [PMID: 31209571 DOI: 10.1007/s00590-019-02470-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 06/12/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Surgical reinsertion of the distal biceps tendon for acute and chronic tears is a widely accepted procedure, but little is known about surgical treatment of distal biceps tendinopathy. METHODS Twenty patients underwent a surgical procedure for distal biceps tendinopathy after failure of conservative treatment. The surgery was performed through a single incision. The biceps tendon was detached, debrided and reinserted using a ToggleLoc (Zimmer Biomet) device. Clinical and radiologic evaluation was performed after a minimum follow-up of 1 year. Quick-Dash score, Liverpool Elbow Score, Mayo Elbow Performance Index, Broberg and Morrey Score and Short HSS Scoring System were used, and isokinetic testing was performed. RESULTS The outcome of these five clinical elbow scores showed no clinically relevant differences between the affected and non-affected side. Isokinetic testing of peak torque in flexion and supination showed equal strength between both sides. These results indicate good functional outcome and recovery of flexion and supination, compared to the non-operated side and the normal population. CONCLUSION This study demonstrates that distal biceps tendon debridement and reinsertion is a safe and valid option for patients with distal biceps tendinopathy after failure of conservative treatment. LEVEL OF EVIDENCE Level 3 retrospective cohort study.
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Affiliation(s)
- Sebastian Faict
- Department of Orthopaedics and Traumatology, OLV Aalst, Moorselbaan 164, 9300, Aalst, Belgium. .,Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090, Brussels, Belgium.
| | | | - Kjell Van Royen
- Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Dries Bleys
- Faculty of Psychology and Educational Sciences, Katholieke Universiteit Leuven (KUL), Tiensestraat 102, 3000, Louvain, Belgium
| | - Wahid Rezaie
- Department of Orthopaedics and Traumatology, OLV Aalst, Moorselbaan 164, 9300, Aalst, Belgium
| | - Bart Middernacht
- Department of Orthopaedics and Traumatology, OLV Aalst, Moorselbaan 164, 9300, Aalst, Belgium
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15
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Lee JH, Kim KC, Lee JH, Ahn KB, Rhyou IH. A Case Series of Symptomatic Distal Biceps Tendinopathy. Clin Shoulder Elb 2018; 21:213-219. [PMID: 33330179 PMCID: PMC7726399 DOI: 10.5397/cise.2018.21.4.213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 08/28/2018] [Accepted: 09/03/2018] [Indexed: 02/03/2023] Open
Abstract
Background The study of conservative and surgical treatment of distal biceps tendinopathy and associated biceps tendon partial rupture. Methods Twenty-one cases with distal biceps tendonitis and partial ruptures were studied who visited Pohang Semyeong Christianity Hospital from June 2010 to August 2017. The mean age was 57.1 years (39–69 years), 14 males and 7 females. The mean duration of symptom at the time of first visit was 4.9 months (0.2–14 months). Ultrasonography and magnetic resonance imaging were performed for patients with severe symptoms. According to the severity of the symptoms, splint immobilization, oral nonsteroidal anti-inflammatory drugs, and ultrasound-guided steroid injection were performed. Surgical treatment was performed if the patient did not respond to conservative treatment for 3 to 6 months or longer. Results There were 9 cases of partial rupture of the distal biceps tendon associated with distal biceps tendinopathy on imaging studies. Conservative treatment showed symptomatic improvement in 16 of 21 cases. In 4 cases with a relatively mild symptom, anti-inflammatory analgesics and intermittent splinting showed good result. In 12 cases, symptoms improved after ultrasonography-guided steroid injection. Surgical treatment was performed on 5 cases that did not respond to conservative treatment. Conclusions Conservative treatment of distal biceps tendinopathy may promise good results. However, in case of partial tear of the distal biceps tendon and refractory to conservative treatment, surgical treatment may be needed.
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Affiliation(s)
- Jung Hyun Lee
- Department of Orthopaedic Surgery, Upper Extremity and Microsurgery Center, Pohang Semyeong Christianity Hospital, Pohang, Korea
| | - Kyung Chul Kim
- Department of Orthopaedic Surgery, Upper Extremity and Microsurgery Center, Pohang Semyeong Christianity Hospital, Pohang, Korea
| | - Ji-Ho Lee
- Department of Orthopaedic Surgery, Upper Extremity and Microsurgery Center, Pohang Semyeong Christianity Hospital, Pohang, Korea
| | - Kee Baek Ahn
- Department of Orthopaedic Surgery, Upper Extremity and Microsurgery Center, Pohang Semyeong Christianity Hospital, Pohang, Korea
| | - In Hyeok Rhyou
- Department of Orthopaedic Surgery, Upper Extremity and Microsurgery Center, Pohang Semyeong Christianity Hospital, Pohang, Korea
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17
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Shim SS, Strauch RJ. A novel clinical test for partial tears of the distal biceps brachii tendon: The TILT sign. Clin Anat 2018; 31:301-303. [DOI: 10.1002/ca.23038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/08/2017] [Accepted: 12/18/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Stephanie S. Shim
- Department of Orthopaedic Surgery; Columbia University Medical Center; New York New York
| | - Robert J. Strauch
- Department of Orthopaedic Surgery; Columbia University Medical Center; New York New York
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Abstract
OBJECTIVE To assess the efficacy and safety of radial extracorporeal shock wave therapy (rESWT) for chronic distal biceps tendinopathy (cDBT). DESIGN Case-control study (level of evidence, 3). SETTING SUN Orthopaedics and Sports Medicine. PATIENTS Patients with a diagnosis of cDBT were recruited between January 2010 and February 2015. INTERVENTIONS Patients received a single session of rESWT (2000 shock waves with energy flux density of 0.18 mJ/mm) or other forms of nonoperative therapy. MAIN OUTCOME MEASURES Patients completed the visual analog scale (VAS), the modified QuickDASH (MQD) score, and the Roles and Maudsley (RM) score over a 12-month period. RESULTS Forty-eight patients completed the final review at 12 months and were included in the study. Subjects ranged in age from 30 to 64 years. Mean pretreatment VAS scores for the rESWT and control groups were 8.3 and 8.5, respectively. Three and 12 months after inclusion in the study, the mean VAS scores for the rESWT and control groups were 3.4 and 5.6 (P < 0.001) and 2.7 and 4.7 (P < 0.001), respectively. Twelve-month follow-up MQD-Sports and MQD-Work scores for the rESWT and control groups were 3.7 and 1.7 (P < 0.001) and 3.8 and 1.8 (P < 0.001), respectively. Differences in mean RM scores were statistically significant between groups at 3 months after the treatment. There were no significant complications. CONCLUSIONS Overall, rESWT is an effective and safe treatment for cDBT. CLINICAL RELEVANCE Radial ESWT as a novel, effective, and safe treatment for cDBT.
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19
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Good isometric and isokinetic power restoration after distal biceps tendon repair with anchors. Arch Orthop Trauma Surg 2017; 137:939-944. [PMID: 28577179 DOI: 10.1007/s00402-017-2724-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Indexed: 01/17/2023]
Abstract
INTRODUCTION 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 2.5 years after surgery. PATIENTS AND METHODS 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. RESULTS 49 patients (71%) were reinvestigated with a follow-up of 32 months (11-58 months). 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. CONCLUSIONS 32 months 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 OF EVIDENCE Level III, case-control study.
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20
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Rupture of the short head component of a bifurcated distal biceps tendon. J Shoulder Elbow Surg 2017; 26:403-408. [PMID: 27979365 DOI: 10.1016/j.jse.2016.09.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/21/2016] [Accepted: 09/29/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rupture of the short head component of a bifurcated distal biceps tendon is a rare injury that may be difficult to diagnose and to treat. METHODS Three cases of patients with selective disruption of the short head of the biceps distal tendon from a single institution are reported. The presenting history, physical examination, imaging studies, operative findings, and treatment strategies are described. RESULTS In each case, the mechanism of injury was forceful flexion of the involved elbow against an eccentric load. Notable physical examination findings included a palpable tendon in the antecubital fossa, a "reverse Popeye" deformity, and pain and weakness with resisted forearm supination and elbow flexion. Careful review of the magnetic resonance imaging studies demonstrated the classic findings for this unique injury. All 3 patients successfully returned to their baseline level of activity after anatomic repair of the short head component with or without independent repair of the long head component (depending on the degree of partial tearing seen intraoperatively). DISCUSSION/CONCLUSIONS Rupture of the short head component of a bifurcated distal biceps tendon is a rare injury that can be easily misdiagnosed and mistreated. A meticulous physical examination and evaluation of imaging is required to differentiate this injury from a partial or complete tear of a common distal biceps tendon. Clinicians should maintain a high index of suspicion for this unusual injury pattern. When it is diagnosed appropriately, selective disruption of the short head of the biceps distal tendon may be effectively treated with anatomic repair.
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Amin NH, Volpi A, Lynch TS, Patel RM, Cerynik DL, Schickendantz MS, Jones MH. Complications of Distal Biceps Tendon Repair: A Meta-analysis of Single-Incision Versus Double-Incision Surgical Technique. Orthop J Sports Med 2016; 4:2325967116668137. [PMID: 27766276 PMCID: PMC5056595 DOI: 10.1177/2325967116668137] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Anatomic reinsertion of the distal biceps is critical for restoring flexion and supination strength. Single- and double-incision surgical techniques have been reported, analyzing complications and outcomes measures. Which technique results in superior clinical outcomes and the lowest associated complications remains unclear. Hypothesis: We hypothesized that rerupture rates would be similar between the 2 techniques, while nerve complications would be higher for the single-incision technique and heterotopic ossification would be more frequent with the double-incision technique. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: A systematic review was conducted using the PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), SPORTSDiscus, and the Cochrane Central Register of Controlled Trials databases to identify articles reporting distal biceps ruptures up to August 2013. We included English-language articles on adult patients with a minimum of 3 cases reporting single- and double-incision techniques. Frequencies of each complication as a percentage of total cases were calculated. Fisher exact tests were used to test the association between frequencies for each repair method, with P < .05 considered statistically significant. Odds ratios with 95% CIs were also computed. Results: A total of 87 articles met the inclusion criteria. Lateral antebrachial cutaneous nerve neurapraxia was the most common complication in the single-incision group, occurring in 77 of 785 cases (9.8%). Heterotopic ossification was the most common complication in the double-incision group, occurring in 36 of 498 cases (7.2%). Conclusion: The overall frequency of reported complications is higher for single-incision distal biceps repair than for double-incision repair. The frequencies of rerupture and nerve complications are both higher for single-incision repairs while the frequency of heterotopic ossification is higher for double-incision repairs. These findings can help surgeons make better-informed decisions about surgical technique and provide their patients with detailed information about expected outcomes and possible complications.
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Affiliation(s)
- Nirav H Amin
- Loma Linda University, Loma Linda, California, USA
| | - Alex Volpi
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - T Sean Lynch
- Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York, USA
| | - Ronak M Patel
- Illinois Bone and Joint Institute, Chicago, Illinois, USA
| | - Douglas L Cerynik
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Mark S Schickendantz
- Cleveland Clinic Center for Sports Health, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Morgan H Jones
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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Partial Tears of the Distal Biceps Brachii Tendon: A Systematic Review of Surgical Outcomes. J Hand Surg Am 2016; 41:e175-89. [PMID: 27212410 DOI: 10.1016/j.jhsa.2016.04.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 04/19/2016] [Accepted: 04/25/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To systematically review the literature regarding surgical outcomes for treatment of partial tears of the distal biceps brachii tendon. METHODS This study was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A systematic review of the literature regarding treatment of partial tears of the distal biceps tendon was conducted using PubMed, Embase, and Cochrane. Inclusion criteria consisted of studies in the English language on the treatment of partial distal biceps tendon tears. Exclusion criteria consisted of (1) studies without outcome data, (2) studies that did not specify the degree of distal biceps tendon tear (ie, complete rupture vs partial tear), and (3) studies without partial tear subgroup data. Two investigators independently reviewed the abstracts from all identified articles. RESULTS Only 5 patients who underwent successful nonsurgical treatment were identified; all were treated with different algorithms, and because of the small number, outcomes for nonsurgical treatment are not included in this review. Therefore, 19 studies involving 86 partial tears that underwent surgical treatment are reported; at least 65 of these received a trial of nonsurgical treatment before surgery. Surgery resulted in 94% satisfactory clinical outcomes. Of the 16 studies (n = 83) that specified the presence or absence of surgical complications, lateral antebrachial cutaneous nerve paresthesia (17%), posterior interosseous nerve palsy (6%), elbow discomfort (2%), surgical revision (2%), and asymptomatic heterotopic ossification (1%) were reported. CONCLUSIONS Surgical treatment including tendon tear completion and anatomic repair to the radial tuberosity can yield satisfactory results and appears to provide predictable outcomes. Further research is necessary to better define the optimal regimen and duration of nonsurgical treatment, as well as the indications for surgery. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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23
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Abstract
Distal biceps tendon ruptures are relatively rare. Patients are usually middle-aged men involved in heavy labor. Patients usually present with the history of a pop and a proximal migration of the biceps muscle belly. Clinical exam should be sufficient to diagnose a complete rupture. Several specific tests have been described. Ultrasound scanning or MRI can help confirm the diagnosis. Radiographs are not needed to diagnose distal biceps tendon rupture but may show typical findings. Imaging, more specifically the flexion-abduction-supination (FABS) view MRI, is particularly helpful in the case of a partial rupture or chronic rupture of the distal biceps tendon. Results of surgical reinsertion of the distal biceps have been shown to be superior to conservative treatment. Different techniques and approaches have been described with specific advantages and disadvantages. Primary repair of the tendon is preferred. If this is no longer possible in chronic tears, an augmentation can be done using tendon graft. Results of surgical treatment are good in the vast majority of patients. Reruptures are rare but minor complications are common. Major complications may include posterior interosseous nerve palsy or radioulnar synostosis, but the risk of these complications may be decreased by meticulous attention to detail during surgery.
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Affiliation(s)
- Melanie Vandenberghe
- Department of Orthopedic Surgery, AZ Monica Hospital, Stevenslei 20, 2100, Deurne, Belgium
| | - Roger van Riet
- Department of Orthopedic Surgery, AZ Monica Hospital, Stevenslei 20, 2100, Deurne, Belgium. .,Department of Orthopedic Surgery, University Hospital Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium. .,Department of Orthopedic Surgery, Erasme University Hospital, Route De Lennik 808, Brussels, Belgium.
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Alemann G, Dietsch E, Gallinet D, Obert L, Kastler B, Aubry S. Repair of distal biceps brachii tendon assessed with 3-T magnetic resonance imaging and correlation with functional outcome. Skeletal Radiol 2015; 44:629-39. [PMID: 25503858 DOI: 10.1007/s00256-014-2079-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 10/24/2014] [Accepted: 12/04/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Objectives were to study the MRI appearance of the repaired distal biceps tendon (DBT), anatomically reinserted, and to search for a correlation between tendon measurements and functional results. MATERIALS AND METHODS Twenty-five patients (mean age, 49 ± 4.9 years old) who benefited from 3-T MRI follow-up of the elbow after surgical reinsertion of the DBT were retrospectively included and compared to a control group (n = 25; mean age, 48 ± 10 years old). MRI was performed during the month of clinical follow-up and on average 22 months after surgery. Delayed complications (secondary avulsion, new rupture), intratendinous osteoma, tendinous signal on T1-weighted (T1w) and fat-suppressed proton density-weighted (FS-PDw) images as well as DBT measurements were recorded. The maximum isometric elbow flexion strength (MEFS) and range of motion of the elbow were assessed. RESULTS Repaired DBT demonstrated a heterogeneous but normally fibrillar structure. Its low T1w signal was less pronounced than that of normal tendons, and the FS-PDW image signal was similar to that of T1w images. MRI detected seven osteomas (Se = 53 % vs. plain radiography), one textiloma and one secondary avulsion. Repaired DBT measurements were significantly correlated with MEFS (dominant arm R2: 0.38; nondominant arm R2: 0.54); this correlation involved the insertion surface (Δ = -75.7 mm(2), p = 0.046), transverse diameter (Δ = -2.6 mm, p = 0.018), anteroposterior diameter at the level of the radial head (Δ = -3.9 mm, p = 0.001) and DBT cross-sectional area (Δ = -50.2 mm(2), p = 0.003). CONCLUSION The quality of functional outcome after anatomical elbow rehabilitation of DBT correlates with the extent of tendinous hypertrophy during the healing process.
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Affiliation(s)
- Guillaume Alemann
- Department of Musculoskeletal Imaging, University Hospital of Besancon, 3 boulevard Fleming, 25000, Besancon, France,
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Barker SL, Bell SN, Connell D, Coghlan JA. Ultrasound-guided platelet-rich plasma injection for distal biceps tendinopathy. Shoulder Elbow 2015; 7:110-4. [PMID: 27582965 PMCID: PMC4935115 DOI: 10.1177/1758573214567558] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 10/17/2014] [Indexed: 12/24/2022]
Abstract
BACKGROUND Distal biceps tendinopathy is an uncommon cause of elbow pain. The optimum treatment for cases refractory to conservative treatment is unclear. Platelet-rich plasma has been used successfully for other tendinopathies around the elbow. METHODS Six patients with clinical and radiological evidence of distal biceps tendinopathy underwent ultrasound-guided platelet-rich plasma (PRP) injection. Clinical examination findings, visual analogue score (VAS) for pain and Mayo Elbow Performance scores were recorded. RESULTS The Mayo Elbow Performance Score improved from 68.3 (range 65 to 85) (fair function) to 95 (range 85 to 100) (excellent function). The VAS at rest improved from a mean of 2.25 (range 2 to 5) pre-injection to 0. The VAS with movement improved from a mean of 7.25 (range 5 to 8) pre-injection to 1.3 (range 0 to 2). No complications were noted. DISCUSSION Ultrasound-guided PRP injection appears to be a safe and effective treatment for recalcitrant cases of distal biceps tendinopathy. Further investigation with a randomized controlled trial is needed to fully assess its efficacy.
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Affiliation(s)
- Scott L Barker
- Melbourne Shoulder and Elbow Centre, Brighton,
Melbourne, VIC, Australia,Monash University Department of Surgery,
Monash Medical Centre, Clayton, Melbourne, VIC, Australia,Mr Scott L Barker, Woodend Hospital, Eday Road,
Aberdeen, AB15 6XS, Scotland, UK. Tel: +44 (0)1224 556508. Fax: +44 1224 556376.
| | - Simon N Bell
- Melbourne Shoulder and Elbow Centre, Brighton,
Melbourne, VIC, Australia,Monash University Department of Surgery,
Monash Medical Centre, Clayton, Melbourne, VIC, Australia
| | - David Connell
- Olympic Park Imaging, AAMI Park, Melbourne,
VIC, Australia
| | - Jennifer A Coghlan
- Melbourne Shoulder and Elbow Centre, Brighton,
Melbourne, VIC, Australia,Monash University Department of Surgery,
Monash Medical Centre, Clayton, Melbourne, VIC, Australia
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Hinchey JW, Aronowitz JG, Sanchez-Sotelo J, Morrey BF. Re-rupture rate of primarily repaired distal biceps tendon injuries. J Shoulder Elbow Surg 2014; 23:850-4. [PMID: 24774620 DOI: 10.1016/j.jse.2014.02.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 01/28/2014] [Accepted: 02/10/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Distal biceps tendon rupture is a common injury, and primary repair results in excellent return of function and strength. Complications resulting from distal biceps tendon repairs are well reported, but the incidence of re-ruptures has never been investigated. METHODS A search of the Mayo Clinic's Medical/Surgical Index was performed, and all distal biceps tendon repairs from January 1981 through May 2009 were identified. All patients who completed 12 months or more of follow-up were included. All charts were reviewed and patients contacted as necessary to identify a re-rupture. We also investigated the situation causing the re-rupture. RESULTS We identified a total of 190 distal biceps tendon ruptures that underwent repair and met our inclusion and exclusion criteria. Of the 190 repairs, 172 (90.5%) were performed by the Mayo modification of the Boyd-Anderson 2-incision technique. Bilateral ruptures occurred in 13 patients (7.3%). Six primary ruptures (3.2%) occurred in women, 4 of the 6 being partial ruptures. Partial ruptures were found to be statistically more common than complete ruptures in women (P = .05). We identified 3 re-ruptures (1.5%), all occurring within 3 weeks of the index surgery. CONCLUSION The re-rupture rate after primary repair of the distal biceps tendon is low at 1.5% and occurs within 3 weeks of index repair. This appears to be due to patient compliance and excessive force placed on repairs. We also found the incidence of women who sustain a distal biceps tendon tear to be 3.2%, with partial tears being statistically more common than complete ruptures. LEVEL OF EVIDENCE Level IV, case series, treatment study
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Affiliation(s)
- John W Hinchey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Bernard F Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Flint JH, Wade AM, Giuliani J, Rue JP. Defining the terms acute and chronic in orthopaedic sports injuries: a systematic review. Am J Sports Med 2014; 42:235-41. [PMID: 23749341 DOI: 10.1177/0363546513490656] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although many authors report on acute injuries and chronic injuries in the orthopaedic literature, the actual terms are seldom explicitly defined. HYPOTHESIS Much of the literature pertaining to sports injuries that are acute or chronic does not define these terms. It is believed that definitions will provide clarity and specificity in future literature. STUDY DESIGN Systematic review. METHODS A systematic review of 116 articles was conducted to determine whether and how the terms acute and chronic were defined as they pertain to several commonly treated conditions: Achilles tendon rupture, distal biceps tendon rupture, pectoralis major tendon rupture, anterior cruciate ligament (ACL) tear, anterior shoulder instability, and acromioclavicular (AC) joint dislocation. Articles were isolated from various databases and search engines by use of keywords to identify relevant literature. RESULTS This study determined that the terms acute and chronic for each injury are defined, respectively, as follows: Achilles tendon rupture: <1 week, >4 weeks; distal biceps tendon rupture: <6 weeks, >12 weeks; pectoralis major tendon rupture: <6 weeks, >6 weeks; ACL tear: <6 weeks, >6 months; anterior shoulder instability: <2 weeks, >6 months; AC joint dislocation, <3 weeks, >6 weeks. CONCLUSION The current literature varies greatly in defining the terms acute and chronic in common sports injuries. The vast majority of authors imply these terms, based on the method of their studies, rather than define them explicitly. Injuries involving tendons showed greater consistency among authors, thus making a definition based on consensus easier to derive. The literature on ACL and shoulder instability in particular showed great variability in defining these terms, likely representing the more complex nature of these injuries and the fact that timing of surgery in the majority of patients does not particularly affect the complexity of the surgical approach and treatment. CLINICAL RELEVANCE Defining injuries as acute or chronic is clinically relevant in many cases, particularly concerning tendon injuries, where these terms have implications regarding the anatomic pathologic changes and tissue quality, which may necessitate augmentation and alter the initial surgical plan. In cases where these terms are less pertinent to operative treatment considerations, they bring clarity to the discussion of the acuity of the injury (as it pertains to time from insult).
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Affiliation(s)
- James H Flint
- James H. Flint, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889-5600.
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Donaldson O, Vannet N, Gosens T, Kulkarni R. Tendinopathies Around the Elbow Part 2: Medial Elbow, Distal Biceps and Triceps Tendinopathies. Shoulder Elbow 2014; 6:47-56. [PMID: 27582910 PMCID: PMC4986646 DOI: 10.1111/sae.12022] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 04/19/2013] [Indexed: 01/17/2023]
Abstract
In the second part of this review article the management of medial elbow tendinopathy, distal biceps and distal triceps tendinopathy will be discussed. There is a scarcity of publications concerning any of these tendinopathies. This review will summarise the current best available evidence in their management. Medial elbow tendinopathy, also known as Golfer's elbow, is up to 6 times less common than lateral elbow tendinopathy. The tendinopathy occurs in the insertion of pronator teres and flexor carpi radialis. Diagnosis is usually apparent through a detailed history and examination but care must be made to exclude other conditions affecting the ulnar nerve or less commonly the ulnar collateral ligament complex. If doubt exists then MRI/US and electrophysiology can be used. Treatment follows a similar pattern to that of lateral elbow tendinopathy. Acute management is with activity modification and topical NSAIDs. Injection therapy and surgical excision are utilised for recalcitrant cases. Distal biceps and triceps tendinopathies are very rare and there is limited evidence published. Sequelae of tendinopathy include tendon rupture and so it is vital to manage these tendinopathies appropriately in order to minimise this significant complication. Their management and that of partial tears will be considered.
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Affiliation(s)
| | - Nicola Vannet
- Department of Orthopaedics, Royal Gwent Hospital, Newport, UK
| | - Taco Gosens
- Department of Orthopaedics and Traumatology, St Elisabeth Hospital, Tilburg, Netherlands
| | - Rohit Kulkarni
- Department of Orthopaedics, Royal Gwent Hospital, Newport, UK
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Schmidt CC, Jarrett CD, Brown BT. The distal biceps tendon. J Hand Surg Am 2013; 38:811-21; quiz 821. [PMID: 23474326 DOI: 10.1016/j.jhsa.2013.01.042] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 01/28/2013] [Indexed: 02/02/2023]
Abstract
Distal biceps tendon ruptures continue to be an important injury seen and treated by upper extremity surgeons. Since the mid-1980s, the emphasis has been placed on techniques that limit complications or improve initial tendon-to-bone fixation strength. Recently, basic science research has expanded the knowledge base regarding the biceps tendon structure, footprint anatomy, and biomechanics. Clinical data have further delineated the results of conservative and surgical management of both partial and complete tears in acute or chronic states. The current literature on the distal biceps tendon is described in detail.
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Affiliation(s)
- Christopher C Schmidt
- Orthopedic Specialists-UPMC, University of Pittsburgh Medical Center, Pittsburgh, PA 15237, USA.
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Abstract
Context: Elbow tendinopathy is a common cause of pain and disability among patients presenting to orthopaedic surgeons, primary care physicians, physical therapists, and athletic trainers. Prompt and accurate diagnosis of these conditions facilitates a directed treatment regimen. A thorough understanding of the natural history of these injuries and treatment outcomes will enable the appropriate management of patients and their expectations. Evidence Acquisitions: The PubMed database was searched in December 2011 for English-language articles pertaining to elbow tendinopathy. Results: Epidemiologic data as well as multiple subjective and objective outcome measures were investigated to elucidate the incidence of medial epicondylitis, lateral epicondylitis, distal biceps and triceps ruptures, and the efficacy of various treatments. Conclusions: Medial and lateral epicondylitis are overuse injuries that respond well to nonoperative management. Their etiology is degenerative and related to repetitive overuse and underlying tendinopathy. Nonsteroidal anti-inflammatory drugs and localized corticosteroid injections yield moderate symptomatic relief in short term but do not demonstrate benefit on long-term follow-up. Platelet-rich plasma injections may be advantageous in cases of chronic lateral epicondylitis. If 6 to 12 months of nonoperative treatment fails, then surgical intervention can be undertaken. Distal biceps and triceps tendon ruptures, in contrast, have an acute traumatic etiology that may be superimposed on underlying tendinopathy. Prompt diagnosis and treatment improve outcomes. While partial ruptures confirmed with magnetic resonance imaging can be treated nonoperatively with immobilization, complete ruptures should be addressed with primary repair within 3 to 4 weeks of injury.
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Jarrett CD, Weir DM, Stuffmann ES, Jain S, Miller MC, Schmidt CC. Anatomic and biomechanical analysis of the short and long head components of the distal biceps tendon. J Shoulder Elbow Surg 2012; 21:942-8. [PMID: 21813298 DOI: 10.1016/j.jse.2011.04.030] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 04/09/2011] [Accepted: 04/22/2011] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The short head bundle of the distal biceps tendon is more efficient at elbow flexion, and the long head is more efficient at forearm supination. METHODS The short and long head bundles of the distal biceps tendon were separated to the bicipital tuberosity in 6 cadavers. The area and centroid of each bundle insertion were computed from surface points measured within each footprint. Each bundle was individually loaded. The supination torque and flexion load generated were recorded at 90° of elbow flexion. The slope of the torque generated versus biceps load was used to define the supination moment arm. The ratio of the flexion load generated to biceps load applied was used to define the relative flexion efficiency. RESULTS The short head insertion was positioned distal and anterior relative to the long head and typically included the apex of the tuberosity. The areas of the long and short heads were 59 ± 15 and 94 ± 44 mm(2) (P = .07), respectively. The long head moment arm was significantly higher in supination. The short head had a significantly higher moment arm in neutral and pronation. The ratio of the flexion load to biceps load was 15% higher for the short head. CONCLUSION The short and long heads of the biceps have distinct insertions. The short head's insertion allows it to be relatively more efficient at elbow flexion at 90°. In the neutral and pronated forearm, the short head is the relatively more efficient supinator. In the supinated forearm, the long head becomes relatively more efficient at supination.
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Affiliation(s)
- Claudius D Jarrett
- Department of Orthopaedics, Division of Upper Extremity Surgery, Allegheny General Hospital, Pittsburgh, PA 15212, USA
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Matthias V, van Riet Roger P. Reconstruction after Distal Biceps Tendon Rupture. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2012. [DOI: 10.1016/j.jotr.2011.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Distal biceps ruptures are relatively uncommon, but should be diagnosed and treated promptly to have good outcome. In this review article we will briefly summarize the anatomy and mechanism of injury, but the focus of this article will be on diagnosis and treatment. The most up to date techniques for clinical examination are described. For the treatment, the most common surgical approach and fixation methods are explained. Throughout the article, the author shares his experience (inlcuding the author's preferred technique) in treating this pathology.
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Affiliation(s)
- Vanhees Matthias
- Department of Orthopedic Surgery, Monica Hospital, Monica Research Foundation, Antwerp, Belgium
- Orthopedic Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Mayo Foundation, Rochester, MN, USA
| | - P. van Riet Roger
- Department of Orthopedic Surgery, Monica Hospital, Monica Research Foundation, Antwerp, Belgium
- Departement de Orthopédie Traumatologie, Université Libre Brussels, Brussels, Belgium
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Cho CH, Song KS, Choi IJ, Kim DK, Lee JH, Kim HT, Moon YS. Insertional anatomy and clinical relevance of the distal biceps tendon. Knee Surg Sports Traumatol Arthrosc 2011; 19:1930-5. [PMID: 21698491 DOI: 10.1007/s00167-011-1586-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Accepted: 06/14/2011] [Indexed: 12/01/2022]
Abstract
PURPOSE This study was undertaken to evaluate the incidence of bifurcated distal biceps tendons and the tendon's insertional footprint on the radial tuberosity. METHODS Twenty-five embalmed cadaveric specimens were dissected. The relationships and orientation of the muscle bellies and distal biceps tendon were examined. The insertional length, width, and footprint area of the distal biceps tendon on the radial tuberosity were evaluated. RESULTS In 12 specimens (48%), the distal biceps tendon was in 2 distinct, easily separated parts. The average footprint length, width, and area of the tendon's insertion on the radial tuberosity were 20.5 mm ± 2.0 mm, 9.7 mm ± 1.3 mm, and 156.3 mm(2) ± 29.4 mm(2), respectively. We calculated that the tendon's insertion occupied approximately 35.9% of the area of the radial tuberosity. In the specimens with a bifurcated distal biceps tendon, the long head of the tendon inserted at the posterosuperior portion of the radial tuberosity, and the average area was 71.4 mm(2) ± 11.3 mm(2). The short head of the distal biceps tendon inserted at the anteroinferior portion, and the average area was 88.3 mm(2) ± 24.1 mm(2). CONCLUSION This study confirmed that bifurcated distal biceps tendon insertion is not a rare anatomical variation, showed by recent investigations, and found that the short head of the distal biceps tendon was inserted more anteriorly than the long head on the radial tuberosity. These findings may allow functional independence and isolated rupture of each portion. It can make correct diagnosis possible and allow for a more anatomical orientation of the tendon during surgical repair.
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Affiliation(s)
- Chul-Hyun Cho
- Department of Orthopedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, 194 Dongsan-dong, Joong-gu, Daegu 700-712, Korea.
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