distal biceps tendon rupture:
Ruptures of the distal biceps tendon are almost always caused by a sudden injury to the elbow.
In most cases, the distal biceps tendon rupture are complete ruptures,
such that the tendon has completely detached from its attachment point at the bone.
Partial tears can occur,
in which the tendon is not fully detached and can still be palpated at the elbow flexion crease.
The risk of rupture is increased in those who have used growth factor supplements to increase muscle gain
because these drugs allow the muscle to grow too quickly for the tendon to adapt.
Nicotine use can affect tendon strength and quality.
Symptoms.
When the distal biceps tendon ruptures,
it usually sounds and feels like a pop directly in front of the elbow if it is a complete rupture.
At first the pain is intense.
The pain often subsides quickly after a complete rupture.
whereas, in partial ruptures, pain tends to persist.
If completely ruptured, the tendon can retract toward the shoulder creating a bulge in the upper arm
- the so-called “reverse Popeye sign”.
There may also be a hollow area at the elbow created by the absence of the tendon.
Swelling and bruising in front of the elbow usually develop shortly after the pop and could spread to the forearm.
From a functional standpoint, if left untreated,
some weakness in both flexion and rotating your forearm outwards "supination" will be noted.
Supination is usually affected more than elbow flexion.
However, multiple muscle groups are used in both motions,
and no deficit in functional range of motion will result.
Diagnosis.
hook test: the patient flexes the affected elbow to 90 degrees with the forearm fully supinated.
The examiner then attempts to "hook" the distal biceps tendon with their index finger and pull it forward.
An intact tendon moves forward.
A partially intact tendon will move forward, but the action is accompanied by pain.
If no tendon can be found, this marks a positive test for complete distal biceps tendon rupture.
The hook test is subject to false negatives, particularly if the bicipital aponeurosis is intact.
X-rays.
ultrasound.
MRI.
Treatment.
we go for nonoperative treatment in elderly or low-demand patients particularly when it has occurred in a non-dominant arm.
and If the patient has medical problems that put him at higher risk for complications during surgery.
In addition, in patients with missed injuries or those who seek delayed treatment
who may have chronic or “irreparable” tendon ruptures in which the outcome of a surgical repair may not be significantly better than nonoperative management.
Nonsurgical measures may include a protective splint or sling to rest the elbow for 3 to 4 weeks.
Patients may be given anti-inflammatory medicine to help ease pain and swelling.
As symptoms ease, you will usually begin a carefully progressed rehabilitation program under the supervision of a physical therapist.
The program often involves one to two months of therapy.
as I've said before, other arm muscles can substitute for the ruptured biceps tendon
and can provide full motion and reasonable function.
with un-repaired distal biceps ruptures, patients will lose 30% of their flexion power,
and 45% of forearm outwards twisting (supination) torque.
After repair approximately 95% of normal power in both movements is typically restored.
in partial ruptures, it is worth holding off with surgery to see how the patient recovers as his tendon may heal.
If he struggle to recover at three months, the tendon can still normally be repaired at that point.
partial ruptures usually heal within 6-8 weeks.
in complete ruptures, surgery to repair the tendon should be performed during the first 2 to 3 weeks after injury.
After this time, the tendon and biceps muscle begin to scar and shorten,
and the surgery becomes harder,
it may not be possible to restore arm function with surgery.
In a direct repair,
the surgeon begins by making a small incision across the arm, just above the elbow.
he pulls the tendon through the incision.
A scalpel is used to slice off the damaged and degenerated end.
Sutures are then crisscrossed through it.
The original attachment on the radius, the radial tuberosity, is prepared.
The burr is then used to create a small cavity in the bone for the tendon to fit inside and big enough to take a special oblong button.
The tendon is sown onto the button and then passed into the hole prepared and holds on the other side of the bone,
giving excellent strength to the repair.
If more than three or four weeks have passed since the rupture,
the surgeon will usually need to make a larger incision in the front of the elbow.
Also, because the tendon will have retracted further up the arm,
graft tissue will be needed in order to reconnect the biceps to its original point of attachment on the radial tuberosity.
Rehabilitation.
8 сен 2024
