Biceps Tendon Rupture Flashcards
Background of Biceps tendon rupture
Uncommon injury that can be classified as complete or partial
When does BTR usually occur?
Sudden forced extension of a flexed elbow
Risk factors of BTR
Previous episodes of biceps tendinopathy
Steroid use
Smoking
CKD
Fluoroquinolone abx
Clinical features of BTR
Sudden onset pain + weakness of flexion and supination
Pop on rupture
Examination
Marked swelling and bruising in antecubital fossa
Popeye sign (proximal rupture)
Reverse Popeye sign (distal rupture)
+ve Hook test
Explain Hook test
Elbow is actively flexed to 90 degrees and fully supinated.
Examiner attempts to hook their index finger underneath the lateral edge of biceps tendon.
If this cannot be done the tendon is ruptured.
Ix BTR
Diagnosed clinically and can be confirmed by USS.
USS helps the surgeon to localise the distal end of the biceps tendon.
MRI scan might be done if USS is inconclusive but clinical suspicion remains.
General management of BTR
Discussion whether surgery should be done or not.
Flexion and supination can still occur which means that surgical management might not be needed.
Cons of not doing surgery however is that there is marked fatiguability and weakness of flexion and supination.
In lower demand patients a conservative approach might be more suitable.
In that case analgesia and physio becomes mainstay treatment which allows for significant recovery.
Operative management of BTR.
Anterior single incision or dual incision technique.
Explain anterior single incision.
Single incision in antecubital fossa and forming a bone tunnel in the radius to re-insert the ruptured tendon end.
Explain dual incision technique.
A smaller anterior incision in the antecubital fossa and a posterolateral elbow incision between ECU and EDC.
The ruptured tendon end is then re-inserted.
When should surgical repair be done post-injury?
Within a few weeks.
If this is not the case the tendon will retract and scar.
Tendon allograft will have to be done if this happens.
Main complication of operative management.
Injury to lateral antebrachial cutaneous nerve
Posterior interosseus nerve
Radial nerve (rare)
