1. Distal Biceps Rupture
Thomas J Kovack DO

2. Distal Biceps Rupture

3. Normal Anatomy
Biceps muscle is responsible for flexing the forearm and supinating the forearm

4. Injury
Rupture most common in active men between ages of 40 and 60 yrs old
Also seen in younger men who are weighlifters
Pre-existing degenerative changes may predispose tendon to rupture
Usually single traumatic event involving flexion against resistance
Patients often report painful tearing sensation in front of the elbow

5. Injury

6. Injury
Patients present with bruising or swelling in the antecubital fossa
Often is a defect where the tendon used to insert
Patients note weakness in elbow flexion and forearm supination
May have pain and cramping of the biceps muscle

7. Treatment Can be treated non-operatively
Patient should expect 30% decrease in overall flexion strength and 40% decrease in supination strength (Morrey)
Often can have contiuned cramping in the biceps muscle

8. Treatment Decision for surgery:
Surgery allows anatomic re-attachment of tendon
After surgery restoration of strength approaches normal in flexion and supination

9. Surgery Small single incision in front of arm
Tendon is secured into the radius through sutures and anchors
Same day surgery

10. Surgery

11. Surgery

12. Post-op After surgery you are in splint and sling for first week
Weeks 1-4 are spent in Bledsoe brace

13. Post-op Weeks 4 -12 spent working on ROM as tolerated but no lifting
At 3 months can begin biceps curls

14. Risks of Surgery Nerve Injury Arterial Injury Infection Loss of motion
Heterotopic ossification
Risks of anesthesia