Distal Biceps Tendon Rupture

A case Discussion abut Distal Biceps Tendon rupture.
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1. Dr.AHmed Youssef MD Orthopedics Mubarak Alkabeer Hospital Kuwait Distal Biceps Tendon Rupture Case Discussion

2. History Male pt 39 yrs Accountant Weight Lifting during Gym Painful pop Inability to carry things

3. Text Signs

4. Text Provisional Diagnosis Distal Biceps Tendon Rupture

5. Text Anatomy

6. Text Epidemiology Distal biceps tendon rupture represents about 10% of biceps ruptures. Ruptures tend to occur in the dominant elbow (86%) of men (93%) in their 40s. Risk factors ▪ anabolic steroids ▪ smoking  has 7.5x greater risk than nonsmokers

7. Text Mechanism of Injury

8. • History ◦ patient often experiences a painful “pop” as the elbow is eccentrically loaded. • Symptoms ◦ weakness and pain, primarily in supination, are hallmarks of the injury.

9. Signs reverse Popeye sign

10. Motor Examination ▪ loss of more   supination than flexion strength  ▪ loss of 50% sustained supination strength ▪ loss of 40% supination strength ▪ loss of 30% flexion strength

11. Text Provocative tests Hook Test

12. Text Ruland biceps squeeze test

13. Text Imaging X-rays: Usually Normal U/S: Interobserver variability MRI:

14. Text Treatment Conservative: Elderly , low-demand or sedentary patients who are willing to sacrifice function Operative : surgical repair of tendon to tuberosity  lndications ▪ young healthy patients who do not want to sacrifice function   ▪ partial tears that do not respond to nonoperative management

15. Text Fixation Techniques Suture button (400N) > suture anchor (380N) > bone tunnel (310N) > interference screw (230N) Combination technique (suture button + interference screw) stronger than single technique

16. Text Surgical Techniques Single Incision Technique Limited Henry approach Interval between the brachioradialis and pronator teres lateral antebrachial cutaneous nerve (LABCN) is identified as it exits between the biceps and brachialis at antecubital fossa. protect PIN by limiting forceful lateral retraction and maintaining supination

17. Text Complications Injury to the  LABCN  is most common.more LABCN injury than 2-incision approach. Radial nerve or PIN injury is most severe ▪ risk has decreased with new tendon fixation techniques that require less dissection in the antecubital fossa Synostosis and resulting loss of pronation/supination ▪ avoid exposing periosteum of ulna ▪ avoid dissection between the radius and ulna Heterotopic ossification: less common than with 2 incision technique

18. Text Surgical Techniques Dual Incision Technique

19. Text Avoid avoid exposing ulna Do NOT use interval between ECU/anconeus (Kocher's interval) or anconeus and ulna

20. Text Postoperative Immobilize in 110°-130° of flexion and moderate supination

21. Text Complications LABCN injury is most common. Synostosis and heterotopic ossification more common with 2 incision than single incision

22. Thank you