Distal Biceps Rupture

• Distal Biceps Rupture:

  • 3% of all bicep rupture occur at distal aspect
• Distal Biceps Rupture:

  • what
  • tendon rupture/avulsion
  • where
  • distal tendon of biceps brachii
  • how
  • excessive eccentric loading applied to a flexed elbow (heavy lifting)
  • who
  • more common in middle aged males lifting heavy objects
  • body builders, strength athletes, heavy manual workers
• Distal Biceps Rupture - Subjective Features:

  • lifting a heavy object
  • hear/feel a pop at the time of injury
  • sudden sharp/painful tearing sensation - cubital fossa
  • if chronic - may present with anterior elbow pain and flexor strength deficit
• Distal Biceps Rupture - Objective Features:

  • observations
  • swelling and bruising at anterior elbow, contour of distal biceps may be intact
  • popeye sign - retraction of soft tissue
  • ROM
  • usually full unless severe swelling
  • partial tears may present with loss of extension due to pain inhibition
  • strength
  • weakness in forearm supination & elbow flexion
  • special tests
  • Hook test
  • Biceps squeeze test
  • Investigations
  • MRI: partial/complete
• Distal Biceps Rupture - Objective Features - Popeyes Sign:

  • biceps is retracted up after tear
  • wider crease to biceps distance

  
• Distal Biceps Rupture - Management:

  • advice and education
  • full rupture: early operative repair is important
  • partial ruptures: can be managed conservatively
  • exercise
  • post surgery: brace
  • shoulder and wrist exercises
  • ROM exercises
  • gradual strength
  • return to function
  • aim to return to unrestricted sports at 6 months
• Distal Biceps Rupture - Post Op Management pt1:

  • immediately post op
  • bracing to protect the repair
  • check post op notes for permitted ROM
  • Phase 1 (0 - 6 weeks)
  • cryotherapy
  • hand and wrist ROM exercises
  • gripping exercises
  • active and passive glenohumeral joint and scapulothoracic ROM exercises
  • cardiovascular fitness training
  • no active elbow flexion or supination
  • Phase 2 (6 - 12 weeks)
  • isometric triceps at week 6
  • isotonic triceps at weeks 8 - postural control exercises
• Distal Biceps Rupture - Post Op Management pt2:

  • Phase 3 (12 - 16 weeks)
  • isometric biceps at week 12
  • isotonic biceps at week 16 (hammer, traditional & reverse curls)
  • open & closed chain exercises for shoulder girdle
  • Phase 4 (16 weeks +)
  • advanced exercises: side curls, sport related tasks