Distal Biceps Tendon Rupture

Distal Biceps Tendon Rupture
The distal biceps may rupture off the radial tuberosity, just distal to the elbow.

This injury typically occurs as a single traumatic event involving flexion against resistance.
The patient describes a sudden sharp tearing sensation.
 

It presents with painful swollen elbow usually in a 50-60 year old active male, although it is frequently seen in younger sports men.

An obvious deformity of the biceps muscle is noted with the muscle belly shifting upward.

This is often referred to as a "pop-eye" in appearance, after the famous comic character Popeye the sailor man

A palpable defect can be felt at the elbow and the absence of a biceps tendon noted.

Bruising may occur after a couple of days.

This injury left untreated results in a loss of strength of:
30 % decrease in flexion strength
40 % loss of supination strength as in using a screwdriver action;

Surgical treatment

Surgery must be performed as early as possible (certainly within two weeks) to avoid scarring down of biceps.
Repair of the ruptured tendon is usually performed as a day stay procedure.
An incision is placed at the anterior aspect of the elbow. In acute cases this may only need to be a few centimetres, with late diagnosis a longer incision will be required.

The distal biceps is usually found high up in the arm.

Once the tendon has been located a suture is passed through the end of the tendon.

The tract of the biceps tendon is located and the radial tuberosity is located and an anchour inserted.
The distal tendon is attached to the anchour.

The tendon is fixed to the radius from where it was detached.

The wounds are closed and local anaesthetic injected into the wounds.

Post-operative Management
Arm immobilizer (sling) is applied immediately after surgery, with the elbow at 90° flexion.
Elbow movement is commenced at two weeks as tolerated.
Physiotherapy can be commenced after two weeks, starting with very gently elbow range of motion exercises.
The patient is advised not to perform any active flexing at the elbow, lifting or supination  for a period of six weeks.
The patient is advised not to perform any maximal flexion or supination of the forearm for a period of three months.