This document discusses the case of a 39-year-old male weightlifter who experienced a painful pop in his elbow followed by inability to carry things, consistent with a distal biceps tendon rupture. Distal biceps tendon ruptures typically occur in dominant arms of men in their 40s during eccentric loading. Surgical repair is usually recommended for young, active patients to restore function, with fixation techniques like suture buttons providing the strongest repair. Postoperative rehabilitation involves immobilization in flexion and supination.

1. DR.AHMED YOUSSEF
MD ORTHOPEDICS
MUBARAK ALKABEER HOSPITAL
KUWAIT
DISTAL BICEPS TENDON
RUPTURE
CASE DISCUSSION

2. HISTORY
▸Male pt 39 yrs
▸Accountant
▸Weight Lifting during Gym
▸Painful pop
▸Inability to carry things

3. TEXT
SIGNS

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PROVISIONAL DIAGNOSIS
▸Distal Biceps Tendon Rupture

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ANATOMY

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EPIDEMIOLOGY
Distal biceps tendon rupture represents about
10% of biceps ruptures.
Ruptures tend to occur in the dominant elbow
(86%) of men (93%) in their 40s.
Risk factors
▪anabolic steroids
▪smoking has 7.5x greater risk than
nonsmokers

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MECHANISM OF INJURY

9. • HISTORY
◦ PATIENT OFTEN EXPERIENCES A
PAINFUL “POP” AS THE ELBOW IS
ECCENTRICALLY LOADED.
• SYMPTOMS
◦ WEAKNESS AND PAIN, PRIMARILY IN
SUPINATION, ARE HALLMARKS OF THE
INJURY.

10. SIGNS
REVERSE POPEYE SIGN

11. MOTOR EXAMINATION
▪ LOSS OF MORE SUPINATION
THAN FLEXION STRENGTH
▪ LOSS OF 50% SUSTAINED
SUPINATION STRENGTH
▪ LOSS OF 40% SUPINATION
STRENGTH
▪ LOSS OF 30% FLEXION
STRENGTH

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PROVOCATIVE TESTS
▸Hook Test

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Ruland biceps squeeze test

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IMAGING
▸X-rays: Usually Normal
▸U/S: Interobserver variability
▸MRI:

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TREATMENT
▸Conservative: Elderly , low-demand or sedentary patients
who are willing to sacrifice function
▸Operative: surgical repair of tendon to tuberosity
lndications
▪ young healthy patients who do not want to sacrifice
function
▪ partial tears that do not respond to nonoperative
management

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FIXATION TECHNIQUES
▸Suture button (400N) > suture anchor
(380N) > bone tunnel (310N) > interference
screw (230N)
▸Combination technique (suture button +
interference screw) stronger than single
technique

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SURGICAL TECHNIQUES
▸Single Incision Technique
▸Limited Henry approach
Interval between the brachioradialis and pronator teres
lateral antebrachial cutaneous nerve (LABCN) is identified
as it exits between the biceps and brachialis at antecubital
fossa.
protect PIN by limiting forceful lateral retraction and
maintaining supination

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COMPLICATIONS
▸Injury to the LABCN is most common.more LABCN injury than 2-incision
approach.
▸Radial nerve or PIN injury is most severe
▪ risk has decreased with new tendon fixation techniques that require less
dissection in the antecubital fossa
▸Synostosis and resulting loss of pronation/supination
▪ avoid exposing periosteum of ulna
▪ avoid dissection between the radius and ulna
▸Heterotopic ossification: less common than with 2 incision technique

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SURGICAL TECHNIQUES
▸Dual Incision
Technique

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▸Avoid avoid exposing ulna
▸Do NOT use interval between
ECU/anconeus (Kocher's
interval) or anconeus and ulna

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POSTOPERATIVE
▸Immobilize in
110°-130° of
flexion and
moderate
supination

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COMPLICATIONS
▸LABCN injury is most common.
▸Synostosis and heterotopic
ossification more common with 2
incision than single incision