Biceps Rupture Flashcards
What is biceps tendon rupture?
Rupture of the distal biceps tendon is an uncommon injury. It can be classified as either complete (through entire tendon) or partial (remains partly intact) tears.
How does biceps tendon rupture occur?
These injuries typically occur following sudden forced extension of a flexed elbow.
What are the risk factors for biceps tendon rupture?
Those with previous episodes of biceps tendinopathy are at increased risk. Other risk factors for biceps tendon rupture include steroid use, smoking, chronic kidney disease (CKD), or use of fluoroquinolone antibiotics.
What are the clinical features of biceps tendon rupture?
Patients will present with sudden onset pain and weakness at the affected area. Patients often report the feeling of a “pop” during the incident.
Examination demonstrates marked swelling and bruising in the antecubital fossa. As the proximal muscle belly retracts (due to loss of counter traction) a bulge may become evident in the arm; this is termed the “reverse Popeye sign”.
Briefly describt the Hook test
The Hook test is a special test to identify a potential distal tendon rupture:
The elbow is actively flexed to 90º and fully supinated, the examiner attempts to ‘hook’ their index finger underneath the lateral edge of the biceps tendon (which cannot be done in a ruptured biceps tendon).
What investigations should be ordered for biceps tendon rupture?
Whilst cases can be diagnosed clinically, confirmation is usually obtained via ultrasound imaging. This also helps the surgeon localise the distal end of the biceps tendon, which can retract many inches proximally.
If ultrasound imaging is inconclusive but clinical suspicion remains, an MRI scan may be warranted to further assess.
What is shown by the ultrasound scan?
Ultrasound scan of a normal biceps tendon (above) and of a biceps tendon rupture (below).
Why can flexion and supination still occur following biceps tendon rupture?
As elbow flexion and supination can still occur (albeit weakened), due to the remaining action of other associated muscles. Action of the brachialis and supinator muscles allows for flexion at the elbow to remain.
Briefly describe the conservative management of biceps tendon rupture
Accordingly, for lower demand patients, a conservative approach may be most suitable. Analgesia and physiotherapy form the mainstay of conservative management, often allowing for significant recovery of muscle strength and function.
Briefly describe the surgical management of biceps tendon rupture
For those who warrant surgical management, either an anterior single-incision or a dual incision technique will be required. The operation involves forming a bone tunnel in the radius and re-inserting the ruptured tendon end.
Surgical repair should occur within a few weeks of initial injury, otherwise the tendon will retract and scar; in missed cases, reconstruction with tendon allograft is therefore often required.
What is the main complication following surgery of biceps tendon rupture?
The main complications from surgery are injury to lateral antebrachial cutaneous nerve, posterior interosseous nerve, or radial nerve (rare).
