Distal Biceps Ruptures
Quality Orthopaedic Care in Adelaide
A distal biceps rupture refers to the tearing or complete detachment of the biceps tendon from its attachment site at the forearm bone (radius). This injury commonly occurs near the elbow joint and can significantly affect upper limb function. Understanding the causes, symptoms, and treatment options for distal biceps ruptures is important for proper management of this condition.
Causes of pathology
Several factors contribute to the development of distal biceps ruptures. These may include:
- Acute trauma: A sudden and forceful contraction of the biceps muscle, often while the elbow is forcefully straightened against resistance, can lead to a distal biceps rupture.
- Chronic degeneration: Over time, the biceps tendon may undergo degenerative changes, becoming weakened and more susceptible to rupture with repetitive activities or age-related wear and tear.
- Anatomical factors: Certain anatomical variations, such as a shallow bicipital tuberosity or abnormal tendon insertion, can increase the risk of distal biceps ruptures.
Symptoms
The symptoms of a distal biceps rupture may include:
- Sudden pain: Sharp and immediate pain at the front of the elbow or forearm at the time of injury.
- Audible “pop” or snap: Some individuals hear or feel a popping or snapping sensation at the time of the injury.
- Visible deformity: The biceps muscle may appear to “ball up” or “bunch up” near the elbow due to the retraction of the torn tendon. (See photo of “Popeye” sign.)
- Weakness and functional loss: Difficulty with forearm supination (turning the palm upward) and decreased strength in elbow flexion (bending the elbow against resistance).
Treatment options
Non-operative treatment
Non-operative treatment may be considered for individuals with certain lifestyle and activity demands, medical comorbidities, or in cases where surgery is contraindicated. However, it is important to note that non-operative treatment typically results in a significant loss of forearm supination and elbow flexion strength.
Rest and immobilisation: Initially, a period of rest and immobilisation using a splint or brace is recommended to protect the injured tendon.
Physical therapy: Once the acute phase has passed, a physical therapy program may be initiated to improve range of motion, strength, and functional abilities of the affected arm. However, it is important to note that even with physical therapy, there may be a significant loss of forearm supination (up to 50%) and elbow flexion strength (up to 30%).
Operative treatment
Operative treatment is often recommended for individuals who desire to restore strength and function, particularly for those involved in physically demanding activities. Surgical repair or reattachment of the distal biceps tendon can be performed.
Surgical repair: The torn or detached distal biceps tendon is reattached to the bone using various techniques, such as transosseous tunnels with tensionable buttons or suture anchors. This restores the continuity of the tendon and allows for proper healing.
Operative treatment
Rehabilitation: Following surgery, a comprehensive rehabilitation program is crucial to optimise recovery. Physical therapy exercises are initiated to regain range of motion, strength, and functional abilities of the affected arm. The first 6 weeks will concentrate on regaining full elbow range of motion. The next 6 weeks (weeks 6-12 post-surgery) will gradually increase the load to rebuild the strength of the biceps. From 12 weeks post-surgery, patients will typically be cleared for full lifting as tolerated. Patients will be advised not to lift anything over half a kilogram for the first 6 weeks to allow the tendon to heal back onto the bone.
It is important to consult with a healthcare professional to determine the most appropriate treatment approach based on individual factors, severity of the injury, and patient goals.
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