Distal Biceps Rupture
What is Distal Biceps Rupture?
The term distal biceps tendon refers to the tendon at the elbow that connects the biceps muscle of the upper arm to the radius bone of the forearm. This tendon can be torn, most typically at the site where it attaches to the bone.
How does this injury happen?
This injury is almost exclusively seen in men in the 3rd to 5th decade. The distal biceps typically tears from its attachment on the radial tuberosity in the forearm. This occurs suddenly after a rapid contraction of the biceps during resisted elbow activity. There is usually sudden, severe pain in the elbow which may be accompanied by a ‘pop’ or tearing sensation. You may develop bruising in the forearm and the shape of the arm will be altered as the torn tendon retracts into the upper arm. This is called a ‘reverse Popeye’ deformity because of the shape of the arm. The normal contour of the arm is altered which may be unacceptable to some people.
Chronic Tear:
A chronic injury is one in which a period of at least six weeks has passed since the injury without any definitive treatment. The treatment for these chronic injuries may be different than for an acute injury (one that is treated within the first four weeks after the injury). In some cases, it may be possible to treat these in the same way we treat an acute injury, but the complication rate is higher. In chronic tear patients may develop fatigue type of pain as well as weakness in rotating the forearm outward (supination)
Diagnosis
The diagnosis of distal biceps tendon rupture is made on clinical grounds by taking a detailed history and performing a physical examination. Typically the biceps muscle will be bunched in the lower part of the arm, the distance between the elbow crease and the biceps muscle with the elbow bent is increased, the biceps muscle does not move on passive rotation of the forearm and the patient will have a positive hook test.
Investigations:
A plain X-ray is requested to look for any bony abnormality.
MRI is used not only to confirm the diagnosis but also helps in looking at the retraction of the tendon. This also allows to look at any other abnormality in the elbow.
Treatment
- Conservative Treatment:
- In the early stages the injury can be treated by rest, ice and pain killers.
- Chronic distal biceps tendon tears can be left untreated if the individual is managing daily activities, occupation and hobbies without pain or weakness.
- Surgery In Acute Injuries:
- Surgery is indicated in acute cases after discussion with patient and surgeon as it may have an impact on work and ADL.
- Many men simply do not like the appearance of the arm because this injury will typically cause bunching of the biceps muscle and a characteristic Reverse Popeye sign.
- Surgery In Chronic Injuries
- Some people will notice that the arm feels weaker, especially for activities that require a strong twisting motion such as using a screwdriver.
- Cramping type of pain in the biceps muscle.