Distal biceps tendon injury

Introduction Ultrasound is useful in assessing patients with snapping syndromes around the elbow joint. The dynamic nature of the examination allows for direct visualisation of the underlying causative factor. Topic description: We discuss the role of dynamic ultrasound in assessing various snapping syndromes around the elbow, such as ulnar nerve instability, snapping triceps and less commonly, snapping brachialis. Ultrasound is also useful in evaluating the distal biceps tendon, particularly in differentiating partial from complete tendon injury. Discussion Ulnar nerve instability and snapping triceps can be assessed via a medial approach with the transducer placed transversely between the medial epicondyle and the olecranon. In ulnar nerve instability, the nerve can be seen crossing over the medial epicondyle on elbow flexion. In snapping triceps syndrome, both the ulnar nerve and the distal triceps can be seen dislocating over the medial epicondyle. Dynamic assessment of the distal biceps tendon using a lateral approach minimises anisotropy artefact often seen on the anterior approach. Passive pronation and supination of the forearm will reveal little or no movement in a completely torn tendon whereas moving tendon fibres will be appreciated in partial tears. In a snapping brachialis, the medial portion of brachialis will be seen abnormally translocating anterolateral to the medial border of the trochlea during elbow flexion and snapping back into its normal position on elbow extension. Conclusion Dynamic ultrasound of the elbow is valuable in diagnosing patients with snapping sensations around the joint and in evaluating the integrity of the distal biceps tendon.

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Distal Biceps Tendon Repair: An Analysis of Timing of Surgery on Outcomes

Journal of Athletic Training ◽

10.4085/1062-6050-48.1.10 ◽

2013 ◽

Vol 48 (1) ◽

pp. 9-11 ◽

Cited By ~ 9

Author(s):

Oke A. Anakwenze ◽

Keith Baldwin ◽

Joseph A. Abboud

Keyword(s):

Range Of Motion ◽

Biceps Tendon ◽

Tendon Repair ◽

Tendon Injury ◽

Timing Of Surgery ◽

Distal Biceps Tendon ◽

Distal Biceps ◽

Radiographic Outcomes ◽

Biceps Tendon Repair ◽

Injured Patients

Context: Surgical repair of the ruptured distal biceps brachaii tendon is an effective treatment in injured patients. Timing of surgery is considered an important factor when managing these patients. Objective: To compare our outcomes after distal biceps tendon acute (at 4 weeks or less) or chronic (greater than 4 weeks) repair. Design: Cohort study. Setting: Clinical practice. Patients or Other Participants: Of 18 patients in a tertiary practice who underwent distal biceps repair, 12 and 6 underwent acute or chronic repair, respectively. The average durations from injury to surgery were 15.3 (range, 9 to 25) and 50.1 (range, 29 to 75) days for the acute and chronic groups, respectively. Intervention(s): Distal biceps tendon repair. Main Outcome Measure(s): Disabilities of the Arm, Shoulder and Hand (DASH) scoring, range of motion, and clinical and radiographic complications. Results: No differences were noted between the groups in DASH scoring or range of motion. No complications occurred, and radiographic outcomes were satisfactory, without evidence of heterotopic ossification in any patients. Conclusions: Secure repair of a distal biceps tendon injury may yield similar results, whether it is performed in the acute or chronic setting.

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Return to Sport and Weightlifting Analysis Following Distal Biceps Tendon Repair

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2021.01.034 ◽

2021 ◽

Author(s):

Anirudh K. Gowd ◽

Joseph N. Liu ◽

Bhargavi Maheshwer ◽

Grant H. Garcia ◽

Edward C. Beck ◽

...

Keyword(s):

Biceps Tendon ◽

Tendon Repair ◽

Return To Sport ◽

Distal Biceps Tendon ◽

Distal Biceps ◽

Biceps Tendon Repair

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The Role of Deadlifts in Distal Biceps Brachii Tendon Ruptures: An Alternative Mechanism Described With YouTube Videos

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121991811 ◽

2021 ◽

Vol 9 (3) ◽

pp. 232596712199181

Author(s):

Mehmet Kapicioglu ◽

Emre Bilgin ◽

Necip Guven ◽

Anil Pulatkan ◽

Kerem Bilsel

Keyword(s):

Tendon Rupture ◽

Biceps Brachii ◽

Biceps Tendon ◽

Alternative Mechanism ◽

Distal Biceps Tendon ◽

Distal Biceps ◽

Biceps Tendon Rupture ◽

Significant Difference ◽

Biceps Brachii Tendon ◽

Youtube Videos

Background: The classic injury mechanism of a distal biceps brachii tendon rupture (DBBTR) is eccentric loading to the flexed elbow when the forearm is supinated. Purpose: To determine alternative mechanisms of a DBBTR in powerlifting sports, particularly in deadlift competitions, with the use of YouTube videos. Study Design: Descriptive epidemiology study. Methods: A search on YouTube was performed using the search terms “distal biceps tendon rupture” and “distal biceps tendon injury” combined with “competition,” “deadlift,” and “powerlifting.” The videos underwent an evaluation for accuracy by 3 surgeons according to predetermined criteria. Type of sports activity, participant sex, side of the injury, and arm positions at the time of the injury were recorded. Results: Among the videos reviewed, 35 injuries were found appropriate for an evaluation. All participants were male. The majority of the injuries (n = 25) were observed during the deadlift. Only in 1 deadlift injury were both forearms in supination. In the remaining deadlift injuries (n = 24), all elbows were in extension, with 1 forearm in supination and the other in pronation. Among the deadlift injuries in the mixed-grip position, all ruptures occurred in a supinated extremity: 25% (n = 6) of ruptures occurred on the right side, and 75% (n = 18) of ruptures occurred on the left side; this was a significant difference ( P = .014). Conclusion: We described an alternative mechanism for a DBBTR, namely, eccentric loading to an extended elbow when the forearm is supinated during the deadlift. As all the ruptures occurred in a supinated extremity, holding the bar with both forearms in pronation may prevent or decrease the risk of ruptures during the deadlift.

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Distal biceps tendon repairs and reconstructions-an analysis of demographics, prodromal symptoms and complications

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-03750-1 ◽

2021 ◽

Author(s):

Toni Luokkala ◽

Sijin K. Sidharthan ◽

Teemu V. Karjalainen ◽

Juha Paloneva ◽

Adam C. Watts

Keyword(s):

Biceps Tendon ◽

Distal Biceps Tendon ◽

Prodromal Symptoms ◽

Distal Biceps

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

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119827311 ◽

2019 ◽

Vol 7 (2) ◽

pp. 232596711982731 ◽

Cited By ~ 1

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.

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