Distal biceps rupture: Evaluation and management

Abstract

Injury to the distal biceps occurs in certain high risk groups. Anatomical continuity of the lacertus fibrosus has bearing on the extent of retraction of the torn tendon stump. The objective of clinical and imaging evaluation is to discriminate between tendinosis, partial tear, acute complete tear and chronic complete tear. A complete tear of the distal biceps tendon can be diagnosed clinically with the Hook test. The traditional Hook test and the resisted Hook test are useful clinical tests. Though x-rays are routinely done, MRI remains the investigation of choice. Non-operative treatment has a role in selected patients with partial tear or patients with complete tear who have low functional demands. Operative treatment is the recommended treatment for complete tear of the distal biceps and is associated with good functional outcome and patient satisfaction.

Patient-Reported Outcome Measures of a Novel Cortical Button System for Distal Biceps Tendon Repair: A Retrospective Study

“…Predisposing activities include weight lifting, wrestling, or a labour-intensive job [ 1 ]. Risk factors include age, smoking, obesity, use of corticosteroids and overuse; all of which may contribute to tendon degeneration [ 1 , 2 ]. An annual incidence of 1.2-5.4 per 100,000 is reported, with a predilection for men (96%) in their middle age (mean 46.3 years) [ 3 , 4 ].…”

Distal Biceps Brachii Tendon Injuries: An Imaging Update

“…Rupture of the distal biceps brachii tendon (DBBT) is a relatively uncommon injury and typically results from a heavy loading of the distal biceps tendon in the flexed position. It is encountered in certain high-risk groups, such as young sportsmen (especially in contact sports and when using anabolic steroids) and middle-aged patients (from age 40 to 60) sometimes secondary to tendinopathy in elderly people [1].…”

“…An important structure is the 'lacertus fibrosis', a continuation of the internal bicipital aponeurosis that connects the DBBT to the fascia over the forearm flexor muscles and which can prevent retraction of the DBBT in case of complete tendon tear. The amount of proximal retraction of the torn DBBT depends on whether there is a partial or a complete tear and on the integrity of the lacertus fibrosis [1,2] (Figure 1).…”

“…Delayed repair after more than four weeks is associated with less favorable functional outcome and higher failure rate due to shortening of the biceps muscle. Neglected chronic complete rupture or delayed presentation of a complete DBBT rupture may require reconstructive procedure using allograft material [1].…”