Rupture of the distal biceps tendon accounts for 10% of all biceps brachii ruptures. The clinical presentation, surgical treatment, and technique with tenodesis using a unicortical button of the ruptured tendon were presented. The proximal biceps tendon can rupture in a younger patient with activities such as weightlifting or throwing sports. Surgical treatment of partial distal biceps tendon ruptures. The objective of this study is the evaluation of the functional outcome and sport reintroduction in patients operated on for rupture of distal biceps tendon after rehabilitation. Treatment of distal biceps tendon ruptures using a single. Patient safety patient stories resources biceps tendon tear at the elbow the biceps muscle is in the front of your upper arm. The first reported case of avulsion of the distal biceps brachii tendon is credited to starks in 1843. Wikimedia commons has media related to biceps tendon rupture. Studies have described several different methods of patient positioning for optimally imaging the elbow using mri 38. Rupture of the biceps tendon is one of the most com. Tendon rupture occurred within weeks to months of starting nexletol.
Early anatomic reattachment is the goal, no operative treatment typically results in loss of flexion and supination strength and endurance. Mri identified 19 patients as having partial lhb tears, and ten patients were found to have complete rupture of the lhb table 1. It happens most often in middleaged people and is usually due to years of wear and tear on the shoulder. A distal biceps rupture is rare compared to ruptures where the top of the biceps connects at the. Ruptures of the proximal biceps tendon make up nearly all biceps ruptures. Biceps tendon ruptures are more common in the older patient with a history of biceps injury or tendonitis. A distal biceps rupture occurs when the tendon attaching the biceps muscle to the proximal radius is torn from the bone.
The incidence of distal biceps tendon ruptures is 1. Mri of the distal biceps brachii tendon is often difficult because of the anatomic course of the tendon close to its insertion. May 21, 2015 tendon ruptures can usually be diagnosed by clinical assessment. Pdf surgical management of acute distal biceps tendon ruptures. Bicep muscle crampuse of upper arm causes cramping of biceps muscle. Rupture of the distal biceps tendon in a collegiate football player. Mri of distal biceps brachii tendon tears has been described in several articles 3, 7, 8. Sometimes cramping in the biceps muscle is felt prior to rupture. Occasionally, this may cause the biceps tendon to rupture. A tear of the bicep tendon can occur, with symptoms ranging from a gradual or sharp, sudden pain in the upper arm, bruising, tenderness, immobility, or weakness.
Theauthors ofthis study projected an incidence of 1. The operation to repair the tendon aims to restore strength and reduce pain and cramp. Biceps tendon rupture elbow surgery boston medical center. This article covers the causes, risk factors, symptoms, diagnosis, treatment and exercises for biceps tendon rupture. If any exercise increases your pain, stop doing it. It does not cover all diseases, physical conditions, ailments or treatments. A rupture of the biceps most often occurs when the elbow is being pulled in to a straightened. The basic workup for shoulder pain should include assessment of the biceps tendon, which has been considered a common cause of shoulder pain since the 1930s. There have been many suggestions for optimally imaging the elbow using mri 38. Axial imaging is often used, providing shortaxis images of the tendon, to accurately show the anatomy and disease of the distal biceps tendon.
Patients with a distal biceps rupture will have asym. Outcomes and practical information for patients choosing. Nexletol is associated with an increased risk of tendon rupture or injury. Tendons are bands of tough, fibrous tissue connecting a muscle and a bone. One patient had marked thickening of the tendon identified both on ultrasound a. What to know about a torn biceps tendon at the shoulder.
The goal of this study was to evaluate the outcomes of patients selecting nonoperative treatment for distal biceps tendon ruptures to provide information to patients and. These tears are rarely associated with other medical conditions. A biceps tendon tear can happen at either the shoulder or the elbow. Tears of the biceps brachii may occur during athletic activities, however avulsion injuries of the distal biceps tendon are frequently occupational in nature and sustained during forceful, eccentric contraction of the biceps muscle while lifting. Some individuals develop bone spurs in their biceps grooves or under the top of their shoulder blades the acromion, which can lead to wear and tear of their tendons. Rehabilitation guidelines for distal biceps tendon repair. Patients with a distal biceps tendon rupture frequently report. Physical examination all patients underwent a standardized physical examination before surgery. Biceps tendon rupture what is a rupture of the biceps tendon. When the lining becomes inflamed, the tendon cannot glide smoothly in its covering sheath. Xrays and ultrasound are used to establish or confirm the diagnosis but mri gives the most definitive information about the nature and extent of the rupture. Because the rupture involves only the long head tendon of the biceps and not the short head tendon, the biceps still functions. Biceps ruptures are more common in the older patient with a history of biceps injury or tendonitis.
A patient s 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. Rupture of the distal biceps tendon in a collegiate. However, the anatomy of the distal biceps brachii tendon makes imaging of the distal tendon somewhat dif. A distal biceps rupture is rare compared to ruptures where the top of the biceps connects at the shoulder. The tendon is reattached onto the forearm bone with an anchorage device, and this can come in several forms. Injuries typically occur in the dominant elbow of men aged 40 to 49 years during eccentric contraction of the.
Older patients taking corticosteroids or fluoroquinolones also are at increased risk for rupture. As mentioned earlier, the transverse humeral ligament holds the biceps tendon. We report an unusual case of rupture of the long head of the biceps brachii tendon near the musculotendinous junction in a young atheletc patient. In acute biceps tendon ruptures in which a patient will not tolerate resulting functional deficits, anatomical reinsertion of the biceps tendon into the radial tuberosity is usually recommended. A biceps tendon rupture is a complete or partial rupture of a tendon of the biceps brachii muscle. Distal biceps repair surgery with endobutton page 2 of 8 introduction. Attached to the bicep muscle is the bicep tendon, which runs from the elbow to shoulder. The proximal biceps tendon rupture is more common than distal biceps tendon rupture. The shoulder blade is the large, flat, triangular bone that forms the back part of the shoulder. A less frequent injury is a dislocation of the biceps tendon from its groove.
Epidemiology rupture of the distal biceps tendon is a relatively rare injury that may have important functional consequences. Most often, these ruptures occur in patients older than 40 who. This is usually seen in combination with a tear of the subscapularis tendon or the rotator cuff. The patient may have a soft sling for comfort but this can be. The majority of these ruptures occur in the dominant extremity of. When this tension is excessive due to too much repetition or high force, damage to the biceps tendons may occur.
Ruptures of the distal tendon account for only 3% of all biceps tendon ruptures. Highlights of prescribing information tendon rupture. To our knowledge, there are only 2 reports in the literature that use a tenodesis screw alone for fixation of distal biceps tendon ruptures. The tendon that attaches to the radial tuberosity is partially or completely surrounded by a bursa, the bicipitoradial bursa, which ensures frictionless motion between the biceps tendon and the proximal radius during pronation and supination of the forearm. The prognosis for biceps tendon ruptures is good for both surgical repair and for conservative management. Causes of a ruptured biceps tendon the biceps tendon may rupture as a result of chronic tendonitis in the biceps tendon.
A complete tear means the tendon has torn away from the bone. A patient s guide to distal biceps rupture introduction. For additional information or to schedule an appointment, please contact our office. The main cause of a distal biceps tendon tear is a sudden injury. It can affect the distal tendon, or eitherboth of the proximal tendons, attached to the long and short head of the muscle, respectively. Rupture of the long head of the biceps brachii tendon near. Repair of the biceps tendon end of tendon trimmed sutures placed figure 2. When the distal tendon is completely ruptured, the biceps is no longer attached at the elbow and a bulge in the upper arm popeye muscle may appear as the biceps muscle recoils. Pain may diminish if the tendon is completely torn. Table 1 lists the demographic details of these 2 groups. A patients guide to distal biceps rupture introduction. A distal biceps rupture occurs when the tendon attaching the biceps muscle to the elbow is torn from the bone.
Patients usually complain of bulbous mass in the upper arm due to excessive retraction of the. It is most common in patients over 60 years of age and often causes minimal symptoms. Optimal positioning for mri of the distal biceps brachii. Proximal biceps tendon tendinitis may be a grade 1 or 2 strain of the.
If your biceps tendon injury has occurred beyond six weeks ago, a different type of surgery may be needed, and the postoperative advice and information would then be different. Treatment of chronic biceps tendon ruptures request pdf. Spontaneous biceps tendon rupture in a patient with mixed. This leaflet has been designed to provide you with information about the treatment options for distal biceps tendon rupture. If your biceps tendon injury has occurred beyond six weeks ago, a different type of surgery may be needed, and the postoperative advice and information would.
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. This injury occurs mainly in middleaged men during heavy work or lifting. These 847 patients were grouped as no biceps tendon tear 807 95% or partial biceps tendon tear 40 5% patients, as defined by the arthroscopic findings see below. Soon afterward, bruising may develop in the middle of the upper arm and spread down to the elbow. What is a distal biceps tendon repair surgery with an endobutton. Biceps tendon injuries include a spectrum of disorders ranging from mild tendinopathy to complete tendon rupture.
The biceps may appear to have balled up, especially in younger patients whove had a traumatic biceps rupture. A proximal biceps tendon rupture is an injury to the biceps tendon at the shoulder joint. After surgical treatment of partial distal biceps tendon tears, most patients achieved good return of strength with full motion. All 17 patients underwent an mri to assess suspected distal biceps pathology that was interpreted by the radiologist as tendonitis or a partial or complete biceps tendon rupture with no retraction. Audible pop patient hears and feels pop when tendon is separated or ruptured. Distal biceps tendon protocol brigham and womens hospital. The proximal biceps tendon rupture may then occur during a trivial activity, and some patients may experience some pain relief once the damaged tendon ruptures. A patients guide to distal biceps rupture disclaimer. Mri identified 37 patients as having an intact biceps tendon, of which 23 were normal and 14 were reported as intact but characterized by tendinopathy, degenerative changes, or tenosynovitis. If you tear the biceps tendon at the shoulder, you may lose some strength in your arm and have pain when you forcefully turn your arm from palm down to palm up. We cannot definitively attribute our patients tendon ruptures to statin use because only the temporal relationship links statin use to. In younger patients, the biceps tendon is sometimes ruptured during. Complete rupture of large tendons risk factors, signs, and definitive treatment. Rehabilitation guidelines for distal bicep tendon repair uw health.
A biceps rupture most commonly occurs due to sudden or excessive contraction of the biceps. Distal biceps repair surgery wrightington, wigan and leigh. Jan 06, 2020 biceps tendon rupture are of 2 types, proximal biceps tendon rupture and distal biceps tendon rupture. 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. The biceps tendon is not reattached to its original origin. Physical examination for partial tears of the biceps tendon. The biceps tendon sometimes only tears part of the way.
Bend your elbow and bring your hand palm up toward your shoulder. The biceps muscle lies on the front of the upper arm and has two heads. 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. Tendon rupture is a rare complication that occurs in patients receiving corticosteroid therapy. Treatment of a biceps tear depends on the severity of the injury. Nov 02, 2016 bicipital tendinopathy occurs in a variety of sports including weightlifting, tennis, wheelchair athletics and general wheelchair use, cricket, baseball, kayaking and other sports where overhead activity is involved. Fourteen patients failed nonsurgical treatment that consisted of range of motion exercises elbow flexion and extension and forearm supination and pronation and strengthening for elbow flexion. 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. Technique for distal biceps tendon repair distal biceps repair. Multiple tendon ruptures associated with statin therapy. Rupture of the distal biceps tendon in a collegiate football. When is a conservative approach best for proximal biceps. Biceps tendonitis can happen from a direct injury, such as a fall onto the top of the shoulder.
Distal biceps tendon rupture in a female patient request pdf. Distal biceps tendon rupture is usually caused by a single traumatic event involving flexion against resistance, with the elbow at a right angle. They do rupture in the lower arm area, but this is rare. A torn transverse humeral ligament can also lead to biceps tendonitis. Injuries to the biceps tendon at the elbow usually occur when the elbow is forced straight against resistance. Ruptures of the biceps tendon commonly occur in the tendons that connect the bicep to the shoulder blade. Diagnosis and treatment of biceps tendinitis and tendinosis.
The proximal biceps tendon can rupture in a younger patient with activities such as weightlifting or throwing sports, but this is quite unusual. Degenerative tendinosis and biceps tendon rupture are usually seen in older patients. It is by no means intended to be a substitute for ones clinical decision making. Your biceps tendons attach the biceps muscle to bones in the shoulder and in the elbow. The biceps tendon connects the biceps muscle to the shoulder blade scapula and the radius bone in the lower arm. The biceps tendon is one of the anchor points of the biceps muscle, which is important for bending the elbow and rotating the wrist. Degenerative tendinosis and biceps tendon rupture are usually seen in older patients, while isolated tendonitis usually presents in the young or middle aged. Distal repair for a biceps tendon rupture should be considered in patients that injure the bicep in their dominant arm, or active individuals. The combination of the cortical button fixation coupled with an interference screw creates a strong, anatomic repair. This allows me to retrieve the torn end of the tendon, gain access to the bone and. The information in this booklet is compiled from a variety of sources. Most patients who have had surgery for tendonitis can move their arms without pain and regain a full range of motion. An innovation in patient positioning for magnetic resonance mr imaging of the distal biceps tendon was recently described in which the patient lies prone with the arm overhead, the elbow.
The long head of biceps tendon is by far the most commonly ruptured biceps tendon. Rehabilitation guidelines for distal bicep tendon repair. According to a singlecenter study from the united kingdom, among older patients seventh decade of life biceps tendon ruptures occurred at a rate of 0. 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. When this occurs, the condition is known as a biceps tendon rupture. In these conditions, over time the biceps tendon becomes worn and torn, ultimately rupturing. In younger patients, tears of the biceps tendon typically occur where the long head of the biceps attaches to the labrum. Rupture of the distal biceps tendon at the elbow joint is uncommon and. The pdf of the article you requested follows this cover page. This injury type is the most common type of biceps tendon injury. Proximal biceps tendon rupture is usually transverse and either within the shoulder joint or within the proximal part of the intertubercular groove. Traumatic ruptures of the biceps tendon are rare, but serious, and usually involve the long head of the proximal insertion. It is less common to injure this tendon when the elbow is forcibly bent against a heavy load. Patients with biceps tendinitis often complain of a deep.
Surgical treatment of partial distal biceps tendon tears is a viable option after failed nonsurgical treatment. We report a case of a middleaged man with mixed connective tissue disease who presented with spontaneous biceps tendon rupture 5 weeks after initiation of highdose corticosteroid therapy. The arm may feel weak at first with attempts to bend the elbow or lift the shoulder. A history of tendinitis, overuse, or anabolic steroid abuse may predispose tendons to rupture. It helps you bend your elbow and rotate your forearm. A biceps rupture involves a complete tear of the main tendon that attaches the top of the biceps muscle to the shoulder. If you do not have a weight, use a soup can or hammer. A report of 19 patients treated with anatomic reinsertion and a metaanalysis of 147 cases. Risk factors include recurrent tendinitis, a history of a rotator cuff injury, a contralateral biceps tendon rupture, age, poor conditioning and rheumatoid arthritis harwood 2005 triceps tendon rupture. Biceps tendon injuries southern california orthopedic institute.
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