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Review Question - QID 214006

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QID 214006 (Type "214006" in App Search)
A 45-year-old man presents with right upper extremity weakness following an intense workout session. He has weakness most pronounced with attempted supination and the findings depicted in Figure A on clinical examination. The surgeon proceeds with operative repair of his injury using a single-incision technique. How would the most common complication of this surgical treatment manifest?
  • A

Symptomatic heterotopic ossification

4%

74/1819

Weakness in wrist extension

8%

146/1819

Decreased sensation to the volar radial aspect of the forearm

84%

1531/1819

Decreased sensation to the dorsum of the hand

2%

44/1819

Weakness in finger adduction

1%

16/1819

  • A

Select Answer to see Preferred Response

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The most common complication after a distal biceps tendon repair is injury to the lateral antebrachial cutaneous nerve (LABCN), which would present as decreased sensation to the volar radial aspect of the forearm.

Neuropraxia of the LABCN is the most common complication associated with distal biceps repair. The LABCN lies between the biceps and brachialis and crosses the surgical field at the antecubital fossa. Neuropathy is most often related to retraction, particularly when using the 1-incision technique, and typically resolves with time. Other less frequent complications include heterotopic ossification, radioulnar synostosis (more common with the two-incision technique), and posterior interosseous nerve (PIN) palsy.

Miyamoto et al. reviewed distal biceps tendon injuries. The authors reported that there was a higher prevalence of nerve injuries with the single-incision technique and a higher prevalence of heterotopic ossification with the two-incision technique. They concluded that neither approach was definitively superior to the other.

Garon et al. reviewed the complications of distal biceps repair. They reported an overall complication rate of 15-35%, regardless of the operative approach, with the most common being LABCN neurapraxia. The authors concluded that knowledge of anatomy, gentle retraction, and good repair techniques can facilitate good results and decreased complication rates.

Figure A demonstrates an abnormal hook test.
Illustration A shows a normal hook test.

Incorrect Answers:
Answer 1: Heterotopic ossification is a known but less common complication of distal biceps repair. Moreover, heterotopic ossification, when it does occur, is often asymptomatic. Prophylaxis is nevertheless recommended by some authors.
Answer 2: Weakness in wrist extension would most likely be related to a PIN palsy, which is less common than that of the LABCN.
Answer 4: Decreased sensation to the dorsum of the hand would be caused by a superficial radial nerve palsy, which is not a described complication of a distal biceps repair.
Answer 5: Weakness in finger adduction would be caused by an ulnar nerve palsy, which is not a described complication of a distal biceps repair.

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