An Overview of Distal Biceps Tendon Injury

 

An Overview of Distal Biceps Tendon Injury

The Distal Biceps: Anatomy and Function

One of the muscles in the front of the upper arm bone (or humerus), the biceps, contains two muscle bellies, or heads, with different attachments at the shoulder. The "proximal" end of the humerus is where these attachments are found. The two heads of the biceps combine to produce a single distal biceps tendon near the elbow at the other end of the muscle.

This tendon connects the "distal" end of the humerus to the radius bone, one of the forearm's two bones. The biceps contributes in both elbow flexion and supination through this distal attachment on the radius. Supination refers to the movement of the forearm from a "palm down" to a "palm up" position, as when tightening a screw with a screwdriver.

Symptoms and Injury to the Distal Biceps

Partial or full ruptures of the distal biceps tendon are possible injuries. They are most common in middle-aged adults' dominant arm. When the biceps muscle contracts yet the elbow is quickly straightened, such as when a heavy object is attempted to be caught when it falls unexpectedly from a height, unanticipated loading of the tendon is a common mechanism of injury. The wounded tendon usually has some degree of previous illness or degeneration, known as tendinosis, which makes it sensitive to injury. When the biceps tendon is subjected to strong stresses, smokers and people who are not physically active are more susceptible to rupture it.

Pain near the front of the elbow is one of the first signs of a distal biceps rupture. People who have been injured have reported hearing a "pop" from the vicinity. Pain normally goes away after the acute injury, and a chronic distal biceps rupture is rarely painful if left untreated. Bruising of the skin may occur as a result of the injury. The tendon can retract toward the shoulder if it is totally ruptured. If this happens, a cosmetic abnormality in the lower biceps muscle that looks like a spherical lump may appear. There may also be a hollow area where the tendon used to attach at the elbow. The arm, on the other hand, most of the time does not vary much in appearance.

Some weakening will result in forearm flexion and supination, or rotation, from a functional standpoint. Supination is more commonly impacted than elbow flexion. Both motions, however, involve multiple muscle groups, so there will be no loss of functional range of motion. To compensate for the non-functioning, damaged biceps, the other muscular groups might be strengthened. Heavy lifting or the use of a screwdriver, for example, will reveal some residual weakness.

A distal biceps rupture may usually be diagnosed based on the patient's medical history and clinical examination. Magnetic resonance imaging (MRI) may be conducted if a partial tendon damage is suspected or if another injury (fracture, ligament injury, etc.) is suspected.

What is the Treatment for Distal Biceps Ruptures?

A torn distal biceps tendon can be treated in a variety of ways, ranging from conservative care to invasive treatments. The majority of patients will require surgery, however non-operative treatment has a place in the low-demand patient or the patient who is a poor surgical candidate. The treating orthopedic surgeon will go over these alternatives with you and help you choose the best course of action based on your needs, physical exam, and the type of tear seen on imaging investigations including X-rays and magnetic resonance imaging (MRI).

The goal of a non-operative physical therapy treatment regimen is usually to reduce pain and keep the elbow in full range of motion. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Ibuprofen, may also be administered. After the first injury, after the pain has subsided and the elbow motion is normal, treatment may shift to muscle strengthening of the surrounding muscles. Conservative care can result in painless function with some residual weakness and early supination fatigue.

The distal biceps tendon anatomy is restored surgically by fixing the tendon at its insertion location on the radius and allowing it to recover. An open incision in the front of the elbow or a two-incision technique, with a small incision in both the front and back of the elbow, are the most common methods of surgery.

Chronic ruptures are more difficult to treat surgically, and grafts may be required in some cases. Sutures, surgical buttons, anchoring devices, and surgical screws can all be used to repair the tendon to the bone after an acute rupture.

Rehabilitation

The elbow is usually immobilized for a few weeks after surgery before modest range-of-motion activities are started. After two months, the majority of tendon recovery is usually complete, and mild strengthening workouts can begin. The time it takes for patients to return to full activity varies, but most may anticipate to be back to their pre-surgery activities in 4-5 months.

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source

https://www.hss.edu/conditions_distal-biceps-tendon-injury.asp