scholarly journals Return of an Intact Hook Test Result: Clinical Assessment of Biceps Tendon Integrity After Surgical Repair

2019 ◽  
Vol 7 (2) ◽  
pp. 232596711982731 ◽  
Author(s):  
Graham D. Pallante ◽  
Shawn W. O’Driscoll
Keyword(s):  
Surgical Repair ◽  
Biceps Tendon ◽  
Distal Biceps Tendon ◽  
Level Of Evidence ◽  
Distal Biceps ◽  
Effective Manner ◽  
Distal Biceps Repair ◽  
Tendon Ruptures ◽  
Test Result

Background: The hook test is a sensitive and specific tool that has been previously described for diagnosing distal biceps tendon ruptures in an efficient, cost-effective manner. However, its application in postoperative evaluations after surgical repair of distal biceps tendon ruptures is not documented. Hypothesis/Purpose: We hypothesized that the hook test result returns to normal at some point postoperatively after distal biceps repair. This information could be used in decision making during follow-up examinations with both normal and abnormal findings. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: We retrospectively reviewed records of distal biceps repair. Between July 1, 2003, and July 1, 2016, a total of 56 patients underwent distal biceps repair and also had clear documentation of the results of the hook test during the postoperative period. Hook test results consisted of “intact,” “abnormal,” or “absent.” The timing of the return to a normal hook test result was recorded. Results: Overall, 51 of 57 (89%) repairs were documented to have the hook test result return to “intact.” The test result returned to intact by a mean of 10 weeks after surgery (range, 2 weeks to 15 months). The biceps tendon was intact according to the hook test at the 4-month follow-up in 45 of the 51 patients (88%) in whom it ultimately returned. The hook test result was abnormal in 5 repairs in 5 patients with only a short-term follow-up, ranging from 2 to 7 weeks postoperatively. One patient with an abnormal hook test result at 2 weeks postoperatively underwent revision and was confirmed to have a partial tear of the biceps insertion. His hook test result returned to intact 3 months after revision repair. Conclusion: The hook test result returns to normal in patients who undergo distal biceps repair in the primary and revision settings with adequate follow-up. The vast majority of patients have a normal hook test result by 4 months postoperatively. An abnormal hook test result at 4 months postoperatively may indicate a failed repair and should prompt further investigation.

scholarly journals Fixation of Acute Distal Biceps Tendon Ruptures Using Mitek Anchors: A Retrospective Study

2014 ◽  
Vol 8 (1) ◽  
pp. 52-55 ◽  
Author(s):  
M. Al-Taher ◽  
Diederick B. Wouters
Keyword(s):  
Biceps Brachii ◽  
Biceps Tendon ◽  
Tendon Repair ◽  
Functional Results ◽  
Distal Biceps Tendon ◽  
Distal Biceps ◽  
Tendon Ruptures ◽  
Biceps Tendon Repair ◽  
Dash Questionnaire

Purpose of this Study: The aim of this study was to evaluate the outcomes of surgical intra-osseous fixation of the distal tendon of the ruptured biceps brachii muscle using Mitek anchors. Materials and Methods: Between 2005 and 2011, seven patients underwent unilateral distal biceps tendon repair using Mitek anchors. All patients were men aged between 36 and 47 years. Six patients were assessed by physical examination and use of the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Results: Surgery was performed within 3 to 17 days of rupture with a mean follow-up of 35 months. Of the six fully completed DASH questionnaires, three patients had a score of 0, and three patients had scores of 5.8, 10 and 10.8, respectively (10.1 is the mean score for the general population). Transient paraesthesias in the lateral antebrachial cutaneous nerve region occurred in two patients and one patient experienced a transient stiffness of the elbow due to scarring of the wound. No major complicatons have occurred. Conclusion: The use of Mitek anchors for the re-insertion of the ruptured distal biceps tendon proved to be a safe and effective technique with excellent functional results in our series.

scholarly journals Distal Biceps Tendon Repair Using A Single-incision Approach With Unicortical Intramedullary Button Fixation: Report Early Post-operative Outcomes And Complications

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0036
Author(s):  
Kenneth M. Lin ◽  
Justin Chan ◽  
Brian J. Lin ◽  
Christopher L. Camp ◽  
Grant Hoerig Garcia ◽  
...  
Keyword(s):  
Heterotopic Ossification ◽  
Single Incision ◽  
Biceps Tendon ◽  
Tendon Repair ◽  
Distal Biceps Tendon ◽  
Distal Biceps ◽  
Distal Biceps Repair ◽  
Cortical Button ◽  
Biceps Tendon Repair

Objectives: While various techniques for distal biceps repair have been described, biomechanical studies have shown cortical button fixation to outperform bone tunnels, intraosseous screws, and suture anchors. Furthermore, numerous studies have shown no difference in complication rate between single- and dual-incision approaches. Thus, it follows that a single-incision approach with cortical button fixation may provide superior clinical outcomes with minimal complications. The purpose of this study is first to investigate intra-operative and short-term complications of distal biceps tendon repair through a single-incision approach using unicortical button fixation, and secondly to assess clinical outcomes. Methods: 52 patients who underwent distal biceps repair with unicortical button fixation (Figure 1) at a single institution from 2014 to 2017 were identified. Exclusion criteria included age less than 18 or greater than 75 years, prior ipsilateral biceps repair, concomitant ipsilateral surgical procedure, and most recent follow-up less than 2 months. Postoperative nerve deficits, flexion and supination strength by manual testing, range of motion, Mayo Elbow Performance Score (MEPS) and radiographs for identification of heterotopic ossification (HO) were obtained and analyzed retrospectively. Results: Fifty-two patients with 53 distal biceps ruptures were included, with mean age 48 years (range 25-71 years). Median time from injury to surgery was 2 weeks (range 1 day to 16 weeks), with 15 patients being treated at greater than 3 weeks from injury. Forty-four patients (83%) had complete tears. Following surgery, average time to final follow-up was 22.8 weeks (range 8-65 weeks). Postoperatively, 49 patients (92.5%) had full range of motion, 48 patients (90.6%) had return of full supination and flexion strength by manual muscle testing (the remaining patients had strength graded as 5-/5). There was no difference in outcomes between those patients treated < 3 weeks from injury compared to those treated > 3 weeks from injury. Two patients (3.8%) initially reported sensory deficit in the lateral antebrachial cutaneous nerve distribution, both cases of which fully resolved by 7 and 11 weeks postoperative. Two patients (3.8%) displayed radiographic evidence of heterotopic ossification, Hastings and Graham class I (Figure 2). One of these was an incidental finding without any clinical symptoms, the other had mild pain but normal strength and neurovascular function. Mean postoperative MEPS was 93.9 (range 60-100), corresponding to “excellent” function (MEPS>90). Conclusion: Distal biceps repair using single incision, unicortical button fixation yields a low rate of complications with good clinical results compared to other techniques reported in the literature. The single incision approach in patients treated between 3 and 16 weeks from injury is safe and resulted in outcomes no different than in those patients treated <3 weeks from injury. Further investigation is warranted in the form of larger, comparative studies with more robust outcome measures and longer term follow up. [Figure: see text][Figure: see text]

A Combined Technique for Distal Biceps Repair Using a Soft Tissue Button and Biotenodesis Interference Screw

2009 ◽  
Vol 37 (5) ◽  
pp. 989-994 ◽  
Author(s):  
Andrew D. Heinzelmann ◽  
Felix H. Savoie ◽  
J. Randall Ramsey ◽  
Larry D. Field ◽  
Augustus D. Mazzocca
Keyword(s):  
Soft Tissue ◽  
Biceps Tendon ◽  
Interference Screw ◽  
Distal Biceps Tendon ◽  
Distal Biceps ◽  
Early Return ◽  
Accelerated Rehabilitation ◽  
Tendon Ruptures ◽  
Anterior Incision

Background There are many techniques described to repair acute distal biceps tendon ruptures. The authors’ objective is to report the results of a single-incision technique using a combination of a soft tissue button and biotenodesis interference screw with accelerated rehabilitation. Hypothesis Dual fixation of a distal biceps rupture will allow for early return to function. Study Design Case series; Level of evidence, 4. Methods From February 2004 to July 2007, 41 elbows in 40 patients had repair of an acute distal biceps tendon rupture (<6 weeks) through an anterior incision using a soft tissue button and interference screw combined technique. The patients were evaluated pre- and postoperatively with a physical examination, radiographs, and the Andrews-Carson elbow score. Nine patients were unavailable for follow-up. The remaining 31 patients (32 elbows) were contacted for a telephone interview at an average of 24 months postoperatively. Results The preoperative Andrews-Carson score averaged 168 and the postoperative Andrews-Carson score averaged 196 points at final clinical follow-up. There was a statistically significant difference between the pre- and postoperative Andrews-Carson scores (P < .001). One patient had heterotopic ossification associated with decreased pronation and supination. Two superficial radial nerve palsies completely resolved by final follow-up. The average postoperative time to resume normal activities or return to work was 6.5 weeks. Conclusion Repair of acute distal biceps tendon ruptures using a soft tissue button and interference screw technique through a limited anterior incision can allow for accelerated rehabilitation and early return to function.

Differences in risk factors exist for the occurrence of bilateral versus unilateral distal biceps tendon ruptures: a systematic review

2020 ◽  
pp. jisakos-2020-000570
Author(s):  
Christina Barrett Hawkins ◽  
Rebecca Abromitis ◽  
Carola van Eck
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Biceps Tendon ◽  
Meta Analysis ◽  
Distal Biceps Tendon ◽  
Level Of Evidence ◽  
Distal Biceps ◽  
Biceps Rupture ◽  
Tendon Ruptures ◽  
Distal Biceps Rupture

ImportanceDistal biceps rupture is a debilitating injury that is increasing in incidence. A subset of patient experiences this injury on both sides, simultaneously or at separated times. Previous studies have evaluated the incidence and risk factors of unilateral distal biceps rupture. However, little is known about the risk factors for bilateral distal biceps rupture.AimsThis aims of this study were to determine risk factors for bilateral distal biceps rupture and to compare these to the known risk factors for unilateral rupture.Evidence reviewA systematic review of literature was conducted using five databases, producing a total of 1183 papers. After the review process, 31 papers with data bilateral distal biceps tendon ruptures were included.FindingsThe 31 papers included a total of 2234 patients with 2366 ruptures. Patients with a bilateral rupture were younger than patients with unilateral ruptures (45.8 vs 48.8 years old). Women made up a larger percentage of patients with bilateral ruptures (6.8% vs 4.0%). Bilateral injuries occurred most commonly during heavy lifting or falls, whereas forced extension of the arm was the most frequently reported injury mechanism reported with unilateral ruptures. Tobacco used was more common in patients with bilateral ruptures (24.4% vs 6.8%). Labour-intensive occupations and anabolic steroid use did not appear to increase the risk of a bilateral rupture. Pooling of the data was not possible due to heterogeneity of the included studies.ConclusionsWhile differences in risk factors between patients with unilateral and bilateral ruptures were observed, there was too great of a degree of heterogeneity among the studies to perform a meta-analysis of the data.Level of evidenceSystematic review; level III evidence.

scholarly journals Treatment of acute distal biceps tendon ruptures – A survey of the British Elbow and Shoulder Society surgical membership

2021 ◽  
pp. 175857322110329
Author(s):  
MJ Baldwin ◽  
AC Watts ◽  
CA Peach ◽  
J Phadnis ◽  
H Singh ◽  
...  
Keyword(s):  
Online Survey ◽  
Clinical Decision Making ◽  
Surgical Repair ◽  
Biceps Tendon ◽  
Operative Management ◽  
Future Research ◽  
Distal Biceps Tendon ◽  
Distal Biceps ◽  
Biceps Tendon Rupture ◽  
Tendon Ruptures

Background Acute distal biceps tendon ruptures result in weakness and deformity. While in other jurisdictions the rate of surgical repair has outpaced rises in incidence, UK practice for distal biceps tendon ruptures is unknown. The aim of this survey was to characterise current UK clinical practice. Methods An online survey was sent to the surgeon members of the British Elbow and Shoulder Society. Questions covered respondent demographics, clinical decision making, surgical experience and willingness to be involved in future research. Results A total of 242 surgeons responded; 99% undertook acute distal biceps tendon repairs with 83% repairing at least half of all distal biceps tendon ruptures, and 84% of surgeons would have their own, hypothetical, acute distal biceps tendon rupture repaired in their dominant arm and 67% for their non-dominant arm. Patient age, occupation and restoration of strength were the commonest factors underpinning a recommendation of surgical fixation. Most surgeons (87%) supported a national trial to study operative and non-operative treatments. Conclusions UK upper limb surgeons currently advise surgical repair of acute distal biceps tendon ruptures for the majority of their patients. This is despite a paucity of evidence to support improved outcomes following surgical, rather than non-operative, management. There is a clear need for robust clinical evaluation in this area.

Repair of Distal Biceps Tendon Ruptures Using Suture Anchors Through a Single Anterior Incision

2008 ◽  
Vol 24 (1) ◽  
pp. 39-45 ◽  
Author(s):  
Abdul D. Khan ◽  
Sri Penna ◽  
Qi Yin ◽  
Chris Sinopidis ◽  
Peter Brownson ◽  
...  
Keyword(s):  
Biceps Tendon ◽  
Suture Anchors ◽  
Distal Biceps Tendon ◽  
Distal Biceps ◽  
Tendon Ruptures ◽  
Anterior Incision

Repair of Distal Biceps Tendon Ruptures Using a Suture Anchor and an Anterior Approach

2004 ◽  
Vol 29 (2) ◽  
pp. 178-182 ◽  
Author(s):  
L. BALABAUD ◽  
C. RUIZ ◽  
J. NONNENMACHER ◽  
P. SEYNAEVE ◽  
P. KEHR ◽  
...  
Keyword(s):  
Anterior Approach ◽  
Suture Anchor ◽  
Single Incision ◽  
Biceps Tendon ◽  
Clinical Results ◽  
Distal Biceps Tendon ◽  
Isokinetic Testing ◽  
Distal Biceps ◽  
Tendon Ruptures ◽  
A Prospective Study

In a prospective study, eight consecutive patients with nine ruptures of the distal biceps tendon underwent repair through a single incision. All patients were satisfied with their clinical results and had full ranges of elbow and forearm motion. There were no radial nerve injuries and no radio-ulnar synostoses. Isokinetic testing, after correction for dominance, demonstrated a 6% strength deficit, but 7% higher endurance in the repaired extremity for the flexion-concentric test, and no strength deficit and 13% higher endurance for supination. The improved endurance is probably explained by initial reduced effort due to apprehension which minimized subsequent fatigue.

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