CASE HISTORY: Patient is a 31-year-old male who presented himself with a left distal biceps tendon rupture. Patient incurred the injury while performing a deadlifting exercise. PHYSICAL EXAM: Focused examination demonstrated intact skin, the absence of distal biceps, and a noticeable bulge in the upper part of the arm – “Popeye” sign. Swelling was apparent with a gap in the anterior portion of the elbow due to the absence of the tendon. Clinical screening revealed a positive hook test, and limited range of motion (ROM) (i.e., elbow flexion, and pronation and supination of the forearm). DIFFERENTIAL DIAGNOSES: Impingement syndrome; Rotator cuff disease; Shoulder dislocation/instability; Humeral/radial head fracture. TESTS & RESULTS: Patient had an MRI of the left elbow performed that revealed a full distal biceps tendon rupture.FINAL DIAGNOSIS: Complete left distal biceps tendon avulsion. DISCUSSION: Full distal biceps tendon ruptures can be preceded by tendon degeneration and later, tendinopathy. It is not uncommon for a patient to experience biceps tendinitis as well. These pathologies can lead to insufficient blood supply which further potentiates tendon avulsion. With that said, placing a sudden eccentric load on the flexed and supinated forearm will cause a tendon to rupture fully. There are several factors such as age, overuse, and smoking that can also attribute to a tendon rupture. Although surgery is not necessary, it is recommended to regain full function and aesthetic to the arm (i.e., muscle not retracted into the shoulder).OUTCOME OF THE CASE: Patient underwent full tendon repair surgery using the anatomic approach. In this case, the surgical method involved the double incision technique. Using a transverse incision in the antecubital fossa the retracted tendon was resected, and two locking sutures were passed through the distal part of the tendon. Exposing the tuberosity with a muscle splitting technique the biceps tendon was pulled into the bicipital tuberosity, and the sutures were pulled tight then tied. Following surgery, the patient was subjected to wearing a sling for a few weeks. Ibuprofen, Oxycodone, and Meloxicam were prescribed for inflammation, pain, and prevention of heterotopic ossification, respectively. Physical therapy (PT) was prescribed one-month following surgery. PT included the following modalities, Russian estim for muscle re-education, ultrasound to improve tissue healing, intermittent icing to control swelling, voodoo floss banding to improve active ROM, isometric holds with a light load for strengthening of the tendon, occlusion training to rebuild strength, and Kinesio tape for muscle contraction improvement. RETURN TO ACTIVITY AND FURTHER FOLLOW-UP: Three months post-surgery the patient was able to return to activity at his discretion while maintaining a conservative approach. Six months post-surgery the patient was back to his normal activities, despite still having some weakness and slight discomfort in the injured area.
Lotero, Alex and Papadakis, Zacharias
"Left Distal Biceps Tendon Avulsion,"
International Journal of Exercise Science: Conference Proceedings: Vol. 2
, Article 4.
Available at: https://digitalcommons.wku.edu/ijesab/vol2/iss11/4