Distal Biceps Repair



Distal Biceps Repair


Steven M. Andelman, MD

Lauren E. Geaney, MD

Robert A. Arciero, MD

Anthony A. Romeo, MD

Augustus D. Mazzocca, MS, MD


Dr. Geaney or an immediate family member serves as a paid consultant to or is an employee of Paragon 28; has received research or institutional support from Arthrex, Inc.; and serves as a board member, owner, officer, or committee member of the American Orthopaedic Foot & Ankle Society and the Connecticut Orthopaedic Society. Dr. Arciero or an immediate family member has stock or stock options held in Biorez; has received research or institutional support from Arthrex, Inc. and DJ Orthopaedics; and serves as a board member, owner, officer, or committee member of the American Orthopaedic Society for Sports Medicine. Dr. Romeo or an immediate family member has received royalties from Arthrex, Inc.; is a member of a speakers’ bureau or has made paid presentations on behalf of Arthrex, Inc.; serves as a paid consultant to or is an employee of Arthrex, Inc.; has received research or institutional support from Aesculap/B.Braun, Arthrex, Inc., Histogenics, Medipost, NuTech, OrthoSpace, Smith & Nephew, and Zimmer; has received nonincome support (such as equipment or services), commercially derived honoraria, or other non-research-related funding (such as paid travel) from the Arthroscopy Association of North America, Arthrex, Inc., and MLB; and serves as a board member, owner, officer, or committee member of the American Shoulder and Elbow Surgeons, Atreon Orthopaedics, and Orthopedics Today. Dr. Mazzocca or an immediate family member serves as a paid consultant to or is an employee of Arthrex, Inc. and has received research or institutional support from Arthrex, Inc. Neither Dr. Andelman nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this chapter.



PATIENT SELECTION

Patients with an acute distal biceps tendon rupture usually describe a specific event of a sudden extension force on a flexed elbow and may report hearing a “pop” at the time of rupture.1 Initially, the pain is sharp and tearing in the anterior forearm; it evolves into an aching pain persisting for weeks to months. Many have ecchymosis in the antecubital fossa and swelling and tenderness.2 Morrey3 described three criteria for diagnosis: (1) a history of a single traumatic event, (2) grossly palpable and visible signs of proximal retraction of the distal end of the biceps, and (3) weakness of flexion of the elbow and supination of the forearm. The O’Driscoll hook test may be used to identify an absence of the distal insertion:4 The patient’s arm is flexed to 90°, and the patient supinates the arm. If the distal tendon is intact, the examiner can hook a finger underneath. If absent, there is no structure to hook.

Most patients with an acute complete rupture of the distal biceps tendon should be offered surgery.3 These are most often middle-aged, active men. Patients with significant comorbidities may be poor candidates. A discussion is conducted with all patients involving the risks and benefits of the procedure, and more sedentary patients may opt for nonsurgical treatment. In our practice, these patients are given a trial of physical therapy for 3 to 4 weeks and are encouraged to continue daily activities. If symptoms are unbearable at this time, they may undergo surgery. We recommend initial nonsurgical treatment of partial ruptures. If pain continues despite physical therapy, and weakness is unacceptable to the patient, surgical treatment is undertaken. Patients with chronic symptomatic ruptures are also offered surgery.3


PREOPERATIVE IMAGING

AP and lateral radiographs are obtained to rule out fracture or other pathology. Occasionally, hypertrophy or avulsion of the radial tuberosity can be seen.1,4,5 Diagnosis is primarily clinical, but MRI may be helpful for confirmation or in the case of partial ruptures. MRI can also help to identify the amount of tendon retraction for preoperative planning2 (Figures 1 and 2).

image VIDEO 8.1 Cadaveric Demonstration: Distal Biceps Tendon Fixation. Anthony A. Romeo, MD; Augustus D. Mazzocca, MS, MD (32 min)



Feb 2, 2020 | Posted by in ORTHOPEDIC | Comments Off on Distal Biceps Repair
Premium Wordpress Themes by UFO Themes