Distal Biceps Tendon Rupture

ICD-9 Classification / Treatment / Repair

Etiology / Epidemiology / Natural History Associated Injuries / Differential Diagnosis
Anatomy Complications
Clinical Evaluation Follow-up Care
Xray / Diagnositc Tests Review References
synonyms: distal biceps tendon rupture, biceps avulsion, distal biceps tendon tear
Distal Biceps Rupture ICD-9
• 727.69 (rupture of tendon, nontraumatic, other)
• 841.8(sprains and strains of elbow and forearm, other specified sites).
• 905.8(late effect of tendon injury)
Distal Biceps Rupture Etiology / Epidemiology / Natural History
• Most common in dominant extremity of men in 4th-6th decade (50yr/old). All
reported cases of complete distal biceps have been in men. Women have had
partial ruptures reported.
• 40% loss of elbow flexion and suppination power in untreated pts (Morrey BF, JB
1985;67A;418), (Baker BE, JBJS, 1985;67A:414).
• MOI=unexpected extension force applied to arm in 90 degrees of flexion and
supination.
• Partial tears are typically 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).
Distal Biceps Rupture Anatomy
 • Biceps Anatomy
• Typically avulses from its radial tuberosity insertion. +/- rupture of bicipital
aponeurosis.
• The distal biceps tendon runs in a sheath lateral to the median nerve and brachia
artery and medial to the ulnar nerve.
• Distal biceps tendon has two distinct heads: a continuation of the long head and
of the short head. Short head inserts distal to the radial tuberosity, acting more a
an elbow flexor. Long head inserts into the radial tuberosity, acts more a
supinator. (Eames MH, JBJS 2007:89A:1044).
• (Mazzocca AD, JSES 2007;16:122).
• See also Elbow anatomy.
Distal Biceps Rupture Clinical Evaluation
• Sudden, sharp, painful tearing sensaion in antecubital region, occasionally
posterolateral elbow. Gradually (few hours) replaced by dull ache, which may l
for weeks or become chronic.
• Ecchymosis and swelling in antecubital fossa and along medial aspect on arm a
proximal forearm
• Antecubital fossa tenderness
• Biceps muscle belly may be proximally retracted, especially with flexion.
• Palpable defect in bicep tendon. Not as pronounced if bicipital aponeurosis is
intact
• Initially note weakness in supination and flexion. Main long term complaint is
suppination weakness, flexion weakness diminishes with time.
• Partial tears may present with chronic pain in the cubital fossa and biceps
fatigue/weakness.
• Distal Biceps Note
Distal Biceps Rupture Xray / Diagnositc Tests
• A/P, lateral and oblique elbow films indicated. Generally no osseous changes.
Avulsions of portions of radial tuberosity have been reported.
• MRI generally not needed, helpful for suspected partial tears presenting with
chronic pain in the cubital fossa. (Williams BD, Skeletal Radiol, 2001;30:560).
Distal Biceps Rupture Classification / Treatment
• non-operative=elderly, sedentary, to ill for surgery. Long-term outcome =activ
related pain in arm and forearm, decreased strength and endurance in flexion an
supination.
• Acute<4wks: Acute repair indicated. Results are predictably good.
• Chonic>4wks: Repairs of chronic ruptures are dependent on integrity of bicipita
aponeurosis, amount of retraction and scaring. Often difficult to obtain sufficie
length, increased incidence of complications. Often require allograft (Achilles,
semitendinosis).(Wright TW, Tech Hand Upper Extremity Surg 2004;8:167).
• Partial: best treated by releasing remaining tendon, debridement and anatomic
reattachment if fails to respond to nonoperative management.. (Dellaero DT, JSES
2006;15:215)
• eOrthopod Handout. AAOS Handout.