synonyms: distal biceps tendon rupture, biceps avulsion, distal biceps tendon tear
Distal Biceps Rupture ICD-10
A- early stage encounter
D- subsequent encounter
Distal Biceps Rupture ICD-9727.69 (rupture that tendon, nontraumatic, other)841.8(sprains and strains the elbow and also forearm, other specified sites).905.8(late effect of tendon injury)
Distal Biceps Rupture Etiology / epidemiology / organic HistoryMost common in dominant extremity of men in 4th-6thdecade (50yr/old). Every reported cases of complete distal biceps have remained in men. Females have had actually partial ruptures reported.40% loss of elbow flexion and also suppination power in untreated pts (Morrey BF, JBJS 1985;67A;418), (Baker BE, JBJS, 1985;67A:414).Chronic distal biceps ruptures treated non-operatively shorten your forearm arc, rise the contribute of the brachioradialis and also shoulder muscles, and lose 32% of supination strength (Schmidt CC, ASES 2017 Specialty Day).MOI=unexpected extension force (eccentric contraction) used to eight in 90 levels of flexion and supination.Partial tears are frequently from chronic degeneration without acute trauma.Prepisposing Factors: anabolic steriod abuse, bony irregularities of the bicipital ridge, chronic cubital bursitis, smoking. (Safran MR, CORR 2002;404:275).
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Distal Biceps Rupture AnatomyTypically avulses native its radial tuberosity insertion. +/- rupture of bicipital aponeurosis.The distal biceps tendon runs in a sheath lateral to the typical nerve and brachial artery and medial come the ulnar nerve.Distal biceps tendon has two distinctive heads: a continuation of the long head and also of the short head. Short head inserts distal come the radial tuberosity, acting more as an elbow flexor. Long head inserts right into the radial tuberosity, acts much more a supinator. (Eames MH, JBJS 2007:89A:1044).
Distal Biceps Rupture Clinical EvaluationSudden, sharp, ache tearing sensaion in antecubital region, occasionally posterolateral elbow. Slowly (few hours) changed by dull ache, which may last because that weeks or end up being chronic.Ecchymosis and also swelling in antecubital fossa and also along medial element on arm and also proximal forearmAntecubital fossa tendernessBiceps muscle belly may be proximally retracted, specifically with flexion.Palpable defect in bicep tendon. Not as pronounced if bicipital aponeurosis is intactInitially keep in mind weakness in supination and flexion. Main long term complain is suppination weakness, flexion weak diminishes with time.Partial tears may present with chronic pains in the cubital fossa and also biceps fatigue/weakness.Squeeze test: distal arm is squeezed v the elbow flexed 60 to 80 degrees and also the forearm pronated. Undamaged biceps tendon will cause forearm supination. Take it biceps no forearm supination. (Ruland RT, Clin Orthop Relat Res. 2005 Aug;(437):128-31)
Distal Biceps Rupture Xray / Diagnositc TestsA/P, lateraland slope elbow movies indicated. Generally no osseous changes. Avulsions of sections of radial tuberosity have been reported.MRI typically not needed, valuable for doubt partial tears presenting v chronic ache in the cubital fossa. (Williams BD, bones Radiol, 2001;30:560).
Distal Biceps Rupture category / Treatmentnon-operative=elderly, sedentary, come ill for surgery. Irreversible outcome =activity connected pain in arm and forearm, reduced strength and also endurance in flexion and supination.Chonic>4wks: repair of chronic ruptures room dependent on verity of bicipital aponeurosis, amount of retraction and scaring. Often complicated to obtain sufficient length, boosted incidence the complications. Often require allograft (Achilles, semitendinosis). (Wright TW, technology Hand top Extremity Surg 2004;8:167).
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Distal Biceps Rupture associated Injuries / Differential DiagnosisCubital bursitis(enlargement the bursal sac the lies in between bideps tendon and also anterior radial tuberosity)Bicipital tendinosisPartial biceps tendon ruptureEntrapment the lateral antebrachial cutaneous nerveElbow dislocationRadial head fracture
Distal Biceps repair ComplicationsInfectionNerve injury (lateral antebrachial cutaneous, radial/posterior interosseous, median)Rerupture (Bone tunnel fractureRadioulnar synostosis: usually from subperiosteal disssection the the ulna in 2 incision approaches. Dorsal philosophies spliting the extensor carpi ulnaris and extensor digitorum communis there is no exposing the radius minimize the risk.StiffnessAnterior elbow painheterotopic ossificationCRPSKelly EW, JBJS, 2000;82A:1575
Distal Biceps Rupture Follow-up Careimmobilized in ~ 90 degrees elbow flexion, forearm in neutral 7-10days.Hinged flexion-assist splint through 30 degree extension block till 8wks. Might block extension at up to 75 degrees for tenuous repairs and also extend 20 degrees per week beginning at 6weeks post-op.full-extension at 10wksActive flexion begins at 8wks, increase at 12wks, unrestricted use at 16wksfull strength and also endurance meant at 1 yrMorrey = 97% flexion strength, 95% supination strength contrasted to uninjured extremity.
Distal Biceps Rupture testimonial ReferencesRamsey ML, JAAOS 1999;7:199Mazzocca AD, Burton KJ, Romeo AA, Santangelo S, Adams DA, Arciero RA. Biomechanical testimonial of 4 techniques of distal biceps brachii tendon repair. To be J sports Med. 2007 Feb;35(2):252-8. Epub 2006 Dec 27Cain RA, Nydick JA, Stein MI, Williams BD, Polikandriotis JA, Hess AV. Complications complying with distal biceps repair. J Hand Surg Am. 2012 Oct;37(10):2112-7