The biceps brachii participates in elbow flexion, in the supination of the forearm (a movement that allows the palms of the hands to turn upward) and helps to stabilize the shoulder joint.
Biceps pathology covers a spectrum of injuries that can occur from its origin in the shoulder to its insertion in the elbow. In this post, Dr. Almoguera, from the Elgeadi Traumatology team and specialist in upper limb ailments tells us about the rupture of the distal tendon of the biceps brachii.
What is a rupture of the biceps brachii tendon?
Rupture of the distal branchial biceps tendon is a rare injury. It was in 1897 when Johnson published the first case of successful surgical repair of an injury of this type and in 1898 Acquaviva made the first description of this pathology.
Rupture of the distal tendon of the biceps brachii represents only 3% of all ruptures of this tendon.
Why does the distal tendon of the biceps brachii rupture?
Although rupture of the proximal biceps tendon is more common, Rupture of the distal tendon of the biceps brachii (TDBB) is relatively common in middle-aged men (4th-5th decade of life), in the dominant member, especially if they perform manual work or sports training programs of high resistance and heavy loads, with insufficient rest time, stretching or inadequate material.
Rupture of the biceps brachii tendon also has a clear relationship with obesity or high BMI, hypertriglyceridemia, thyroid diseases and hypercalcemia.
Symptoms of a biceps brachii tendon rupture
When the patient has a rupture of the biceps brachii tendon, the symptoms appear immediately, including:
- Intense pain in the affected area
- Functional disability, such as not being able to bend the elbow
- Arm weakness and problems rotating the arm
- Deformity in the normal contour of the upper arm region
- Inflammation of the biceps and bruising where the pain is seen
Diagnosis and treatment of a torn biceps brachii
In this pathology, the examination is the most important thing, so the traumatology specialist will have to differentiate partial tears and total tears.
Professional diagnosis of biceps brachii tendon rupture
The diagnostic is fundamentally clinical. The basic symptoms consist of pain, inflammation and hematoma on the anterior surface of the forearm; accompanied by a decrease in strength and rise of the muscular belly. In some cases, they may report a “click” at the moment of breakage. The Hook test for rupture of the biceps brachii tendon It is the most used with sensitivity and specificity close to 100%. Ultrasound can help confirm clinical suspicion.
Treatment of TDBB rupture
These injuries can be treated conservatively. This treatment modality is useful in the case of elderly patients, with significant comorbidities/high surgical risk, with a chronic injury and/or with low functional demand on the limb.
In the rest of the cases, generally the majority of patients, surgical reattachment of the distal biceps brachii tendon is recommended. There is a large number of surgical techniques, with different approaches and re-anchoring devices, with no clear superiority of any of them over the rest having been demonstrated in the literature.
Probably the most widespread is the reanchoring performed through an incision on the anterior surface of the forearm, using a “Endobutton” type fixation system. The fundamental step occurs when locating the correct insertion area of the tendon in the radius.
Do you have any pathology in your biceps? At Elgeadi Traumatology we have a team of specialist trauma surgeons with years of experience in the treatment of these pathologies using minimally invasive surgical techniques. Make your appointment with the best traumatologists experts in minimally invasive surgery.
