Acute complete and partial distal biceps tendon ruptures: what have we learned? A review

Abstract

Acute distal biceps tendon (DBT) pathology includes bicipitoradial bursitis, tendinosis, partial and complete tears. Diagnosis of complete DBT tears is mainly clinical, whereas in partial tears medical imaging is a valuable addition to the clinical diagnosis. New insights in clinical and medical imaging of partial tears may reduce time to diagnosis and may guide the treatment plan. Most complete tears are best treated with primary repair using either a single-incision or double-incision approach with good clinical outcome. The double-incision technique has a higher risk of heterotopic ossification, whereas a single-incision technique carries a higher risk of nerve-related complications. Intramedullary fixation may be a viable solution to negate the risk of posterior interosseus nerve lesions in single-incision repairs. DBT endoscopy can be used to treat low-grade partial tears and tendinosis. Cite this article: EFORT Open Rev 2021;6:956-965. DOI: 10.1302/2058-5241.6.200145

Challenging the mechanism of distal biceps tendon rupture using a video analysis study

“…In our study, we defined muscle force as isometric, concentric or eccentric according to the direction of motion at the time of rupture and were able to demonstrate that the most common force was actually isometric, rather than eccentric as usually described. 3,4 Neither study performed repeat observations of the videos, 5,6 hence inter-and intraobserver reliability of their findings was not reported as in our study.…”

“…In our study, we defined muscle force as isometric, concentric or eccentric according to the direction of motion at the time of rupture and were able to demonstrate that the most common force was actually isometric, rather than eccentric as usually described. 3 , 4 …”

“…In more contemporary literature, this same description has been refined to describe an eccentric contraction that occurs during mid flexion to cause DBTR. [2][3][4] There has been extensive research into the anatomy, biomechanics, and surgical techniques employed to treat DBTR; however, there has been limited investigation into the exact injury mechanism or how this might affect lifting technique and rehabilitation. [5][6][7] Indeed, the originally proposed mechanism has become so ingrained in our understanding of DBTR that its source is rarely referenced, implying that it is correct beyond doubt.…”

Nanoscopic Distal Biceps Repair With Cortical Button and Interference Screw

“… 1 It is widely accepted that surgery leads to optimal recovery in patients with complete tears. 4 , 5 Without operative repair, a significant decrease in endurance and supination (40%) and flexion (30%) strength can be expected. 3 …”

Prevalence of Amyloid Deposition in Patients Undergoing Surgical Repair of Traumatic Distal Biceps Tendon Ruptures

“…18 , 20 Less commonly, DBT ruptures can occur with more of an attritional mechanism secondary to the progression of partial tears with repetitive microtrauma. 21 , 22 Although it appears that spontaneous DBT ruptures occur frequently in elderly patients with heart failure secondary to cardiac amyloidosis, it remains uncertain if amyloid deposition also occurs frequently in cases of acute traumatic DBT ruptures.…”