Review Question - QID 469

While complete trauamtic rupture of the distal biceps is more common, partial tears have been reported in the literature. The most common presentation is pain in the antecubital fossa worse with resisted supination.

Conservative management consists of NSAID’s, splinting and physical therapy. The distal biceps hook test is helpful in detecting full thickness distal biceps tears but not partial tears.

In one study by Vardakas et al, 7 partial distal biceps ruptures were treated with surgical debridement and reattachment with all patients reporting a significant decrease in their pain. Transfer to the brachialis improves flexion strength but not supination.

Ramsey et al present a review article on distal biceps tendon injuries. They state that the most successful management of partial distal biceps tears that have failed conservative management is to surgically treat it like a complete rupture with release and surgical reattachment of the distal biceps to the radial tuberosity.

Figures A-C are normal radiographs of the elbow. Figure D is a cross-referenced axial and coronal T2 MRI that demonstrates increased signal and partial distal biceps tendon tearing. Illustration C shows the resected region of distal biceps tendon in the same patient and had an excellent functional outcome following distal biceps release and surgical reattachment with 2 double-loaded suture anchors.

Video V demonstrates The hook test for detecting complete distal biceps tendon avulsions.