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Distal Biceps Avulsion
Posted: Feb 20 2015 #(C2154)
A

Distal Biceps Tendon Avulsion in 51M

HPI

51 year old LHD male presents one day following an acute injury to his right elbow (non-dominant) when lifting a heavy object. He felt a pop near his elbow and had immediate pain and swelling. On physical exam, he has decreased ROM and significant ecchymosis around the elbow. Radiographs are negative for fracture or dislocation.

PMH

Healthy. Non-laborer.

PE

Asymmetry of distal biceps (reverse Popeye deformity). Abnormal hook test. Advanced imaging confirms a complete distal biceps rupture with distal stump at level of elbow.

Poll
1 of 6
1. How would you treat the distal biceps avulsion in this patient?
Supportive treatment followed by physical therapy
12%
204/1592
Surgical repair of tendon to tuberosity
87%
1388/1592
2. If choosing operative treatment, what surgical approach would you use for this distal biceps rupture?
Anterior, single curved longitudinal incision (including extended, S-Shaped Henry approach).
41%
630/1532
Anterior, single transverse incision.
20%
315/1532
Two-incision approach (anterior and posterolateral incisions).
18%
276/1532
Anterior, short single longitudinal incision over radial tuberosity
20%
311/1532
3. What type of fixation would you use?
Transosseous suture fixation (ie. bone tunnel).
18%
279/1500
Suture anchor fixation.
24%
370/1500
Suspensory cortical button (ie. endobutton, distal biceps button)
29%
437/1500
Intraosseous screw fixation.
3%
46/1500
Combination of above (ie. suspensory cortical button plus intraosseous screw, or bone tunnel plus intraosseous screw, etc)
24%
368/1500
4. What would be your post-op protocol?
Splint 1-2 weeks, then progressive ROM in brace.
60%
853/1416
Splint 1-2 weeks, then no brace and progressive ROM.
20%
295/1416
Sling immobilization for 1-2 weeks. No splint.
15%
220/1416
No splint or brace.
3%
48/1416
5. When would you allow this patient to return to regular exercises and activities (Sports, weight-lifting in the gym, etc.)?
6 weeks
5%
76/1340
3 months
42%
571/1340
4-5 months
18%
246/1340
6 months
33%
447/1340
6. In a case of unequivocal distal biceps rupture (classic history, deformity, and abnormal hook test) that presents less than one week from injury in active patient in whom repair is preferred management, what advanced imaging (other than radiographs) will you order prior to surgery?
No further imaging is necessary.
28%
392/1390
Ultrasound in clinic, no further imaging.
15%
219/1390
MRI always ordered
54%
764/1390
CT scan
1%
15/1390
PROCEDURE #1

Primary repair of acute distal biceps using socket and cortical button fixation (Distal Biceps Button, Arthrex, Naples, FL)

PROCEDURE #2

NO DESCRIPTION

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OUTCOMES
Post-procedure P1
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