1. Distal Biceps Rupture Thomas J Kovack DO

2. Distal Biceps Rupture

3. Normal Anatomy Biceps muscle is responsible for flexing the forearm and supinating the forearm Biceps muscle is responsible for flexing the forearm and supinating the forearm

4. Injury Rupture most common in active men between ages of 40 and 60 yrs old Rupture most common in active men between ages of 40 and 60 yrs old Also seen in younger men who are weighlifters Also seen in younger men who are weighlifters Pre-existing degenerative changes may predispose tendon to rupture Pre-existing degenerative changes may predispose tendon to rupture Usually single traumatic event involving flexion against resistance Usually single traumatic event involving flexion against resistance Patients often report painful tearing sensation in front of the elbow Patients often report painful tearing sensation in front of the elbow

5. Injury

6. Injury Patients present with bruising or swelling in the antecubital fossa Patients present with bruising or swelling in the antecubital fossa Often is a defect where the tendon used to insert Often is a defect where the tendon used to insert Patients note weakness in elbow flexion and forearm supination Patients note weakness in elbow flexion and forearm supination May have pain and cramping of the biceps muscle May have pain and cramping of the biceps muscle

7. Treatment Can be treated non-operatively Can be treated non-operatively Patient should expect 30% decrease in overall flexion strength and 40% decrease in supination strength ( Morrey ) Patient should expect 30% decrease in overall flexion strength and 40% decrease in supination strength ( Morrey ) Often can have contiuned cramping in the biceps muscle Often can have contiuned cramping in the biceps muscle

8. Treatment Decision for surgery: Decision for surgery: - Surgery allows anatomic re-attachment of tendon - After surgery restoration of strength approaches normal in flexion and supination

9. Surgery Small single incision in front of arm Small single incision in front of arm Tendon is secured into the radius through sutures and anchors Tendon is secured into the radius through sutures and anchors Same day surgery Same day surgery

10. Surgery

11. Surgery

12. Post-op After surgery you are in splint and sling for first week After surgery you are in splint and sling for first week Weeks 1-4 are spent in Bledsoe brace Weeks 1-4 are spent in Bledsoe brace

13. Post-op Weeks 4 -12 spent working on ROM as tolerated but no lifting Weeks 4 -12 spent working on ROM as tolerated but no lifting At 3 months can begin biceps curls At 3 months can begin biceps curls

14. Risks of Surgery Nerve Injury Nerve Injury Arterial Injury Arterial Injury Infection Infection Loss of motion Loss of motion Heterotopic ossification Heterotopic ossification Risks of anesthesia Risks of anesthesia