synonyms: distal biceps tendon rupture, biceps avulsion, distal biceps tendon tear
Distal Biceps Rupture ICD-10
A- initial encounter
D- subsequent encounter
Distal Biceps Rupture ICD-9727.69 (rupture of tendon, nontraumatic, other)841.8(sprains and strains of elbow and forearm, other specified sites).905.8(late impact of tendon injury)
Distal Biceps Rupture Etiology / Epidemiology / Natural HistoryMost widespread in leading extremity of guys in 4th-6thdecade (50yr/old). All reported situations of complete distal biceps have actually remained in men. Womales have had partial ruptures reported.40% loss of elbow flexion and suppicountry power in untreated pts (Morrey BF, JBJS 1985;67A;418), (Baker BE, JBJS, 1985;67A:414).Chronic distal biceps ruptures treated non-operatively shorten their forearm arc, boost the contributions of the brachioradialis and also shoulder muscles, and also shed 32% of supicountry power (Schmidt CC, ASES 2017 Specialty Day).MOI=unexpected expansion force (eccentric contraction) applied to arm in 90 levels of flexion and supicountry.Partial tears are generally from chronic degeneration without acute trauma.Prepisposing Factors: anabolic steriod abusage, bony irregularities of the bicipital ridge, chronic cubital bursitis, smoking cigarettes. (Safran MR, CORR 2002;404:275).
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Distal Biceps Rupture AnatomyTypically avulses from its radial tuberosity insertion. +/- rupture of bicipital aponeurosis.The distal biceps tendon runs in a sheath lateral to the median nerve and also brachial artery and medial to the ulnar nerve.Distal biceps tendon has two distinct heads: a extension of the long head and of the short head. Short head inserts distal to the radial tuberosity, acting even more as an elbow flexor. Long head inserts into the radial tuberosity, acts even more a supinator. (Eames MH, JBJS 2007:89A:1044).
Distal Biceps Rupture Clinical EvaluationSudden, sharp, painful tearing sensaion in antecubital region, sometimes posterolateral elbow. Over time (few hours) reput by dull ache, which might last for weeks or come to be chronic.Ecchymosis and swelling in antecubital fossa and also alengthy medial element on arm and proximal forearmAntecubital fossa tendernessBiceps muscle belly may be proximally retracted, specifically through flexion.Palpable defect in bicep tendon. Not as pronounced if bicipital aponeurosis is intactOriginally note weakness in supicountry and also flexion. Key long term complaint is suppination weakness, flexion weakness diminishes via time.Partial tears may existing with chronic pain in the cubital fossa and biceps fatigue/weakness.Squeeze test: distal arm is squeezed with the elbow flexed 60 to 80 levels and the forearm pronated. Intact biceps tendon will cause forearm supination. Torn biceps no forearm supicountry. (Ruland also RT, Clin Orthop Relat Res. 2005 Aug;(437):128-31)
Distal Biceps Rupture Xray / Diagnositc TestsA/P, lateraland oblique elbow movies indicated. Usually no osseous transforms. Avulsions of sections of radial tuberosity have actually been reported.MRI mostly not necessary, advantageous for suspected partial tears presenting through chronic pain in the cubital fossa. (Williams BD, Skeletal Radiol, 2001;30:560).
Distal Biceps Rupture Classification / Treatmentnon-operative=elderly, sedentary, to ill for surgical procedure. Long-term outcome =activity connected pain in arm and also forearm, reduced stamina and also endurance in flexion and supination.Chonic>4wks: Repairs of chronic ruptures are dependent on integrity of bicipital aponeurosis, amount of retraction and also scaring. Often hard to obtain adequate size, raised incidence of complications. Often call for allograft (Achilles, semitendinosis). (Wright TW, Tech Hand Upper Extremity Surg 2004;8:167).
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Distal Biceps Rupture Associated Injuries / Differential DiagnosisCubital bursitis(enlargement of bursal sac that lies in between bideps tendon and also anterior radial tuberosity)Bicipital tendinosisPartial biceps tendon ruptureEntrapment of lateral antebrachial cutaneous nerveElbow dislocationRadial head fracture
Distal Biceps Repair ComplicationsInfectionNerve injury (lateral antebrachial cutaneous, radial/posterior interosseous, median)Rerupture (Bone tunnel fractureRadioulnar synostosis: mainly from subperiosteal dissarea of the ulna in two incision approaches. Dorsal viewpoints spliting the extensor carpi ulnaris and extensor digitorum communis without exposing the radius minimize the danger.StiffnessAnterior elbow painheterotopic ossificationCRPSKelly EW, JBJS, 2000;82A:1575
Distal Biceps Rupture Follow-up Careimmobilized at 90 degrees elbow flexion, forearm in neutral 7-10days.Hinged flexion-help splint with 30 level expansion block till 8wks. May block expansion at as much as 75 levels for tenuous repairs and extfinish 20 degrees per week starting at 6weeks post-op.full-expansion at 10wksActive flexion begins at 8wks, strengthening at 12wks, unrestricted use at 16wksfull stamina and endurance intended at 1 yrMorrey = 97% flexion toughness, 95% supicountry stamina compared to uninjured extremity.
Distal Biceps Rupture Review 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. Am 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