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Kamineni S, Pooley J, Bachoura A, Yoshida R, Cummings J. Triceps brachii insertional footprint: Under-estimated complexity. Shoulder Elbow 2024; 16:321-329. [PMID: 38818100 PMCID: PMC11135194 DOI: 10.1177/17585732221135633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 10/02/2022] [Accepted: 10/05/2022] [Indexed: 06/01/2024]
Abstract
Background The detailed complexity of triceps brachii insertional footprint continues to challenge surgeons as evidenced by continued reports of triceps-associated complications following elbow procedures. The purpose of this study is to describe the three-dimensional footprint of the triceps brachii at its olecranon insertion at the elbow. Methods 22 cadaveric elbows were dissected leaving only the distal insertion of the triceps intact. The insertion was defined and probed with a three-dimensional digitizer to create a digital three-dimensional footprint allowing width, height, and surface area of the footprint to be recorded relative to the bare area. The insertional soft tissues of tendon versus muscle along with the shape of the footprints were qualitatively described. Results The mean width and surface area of the lateral segment was greater in males than in females (30.07 mm vs. 24.37 mm, p = 0.0339 and 282.1 mm vs. 211. 56 mm, p = 0.0181, respectively). No other statistically significant differences between the sexes were noted. The triceps insertional footprint was "crescent-shaped" and consisted of three regions: central tendon, medial muscular extension, and lateral muscular extension. Discussion These findings can help explain the importance of avoiding these muscular structures during triceps-off approaches and provides the framework for future clinical studies. Clinical Relevance: Basic Science, anatomy study, cadaver dissection.
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Affiliation(s)
- Srinath Kamineni
- Department of Orthopaedic Surgery and Sports Medicine, Elbow Shoulder Research Center, University of Kentucky, Lexington, KY, USA
| | - Joseph Pooley
- Orthopaedic Department, Queen Elizabeth Hospital, Gateshead, UK
| | | | - Ruriko Yoshida
- Department of Operations Research, Naval Postgraduate School, Monterey, CA, USA
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Ritsch M. Bizeps- und Trizepssehnenrupturen im Kraftsport. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00486-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Greif DN, Huntley SH, Alidina S, Muñoz J, Huntley JH, Greditzer HG, Jose J. MRI findings of chronic distal tendon biceps reconstruction and associated post-operative findings. Skeletal Radiol 2021; 50:1095-1109. [PMID: 33236235 DOI: 10.1007/s00256-020-03676-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/29/2020] [Accepted: 11/15/2020] [Indexed: 02/02/2023]
Abstract
Rupture of the distal biceps tendon is becoming increasingly diagnosed due to an active aging population and an increase in diagnostic imaging opportunities. While physical exam may help in diagnosis, magnetic resonance imaging (MRI) is particularly useful in evaluating chronic rupture. Although partial tears can be managed conservatively, the gold standard treatment for a chronic distal biceps tear is anatomic reinsertion with additional use of an allograft or autograft. No study has highlighted the normal appearance and postsurgical complications seen on MRI associated with allograft or autograft usage. Clinicians and radiologists may be unaware of the normal and abnormal post-operative imaging findings and their clinical relevance. The purpose of this manuscript is to discuss the epidemiology, clinical presentation, and preoperative MRI findings of distal biceps ruptures necessitating reconstruction, to explain distal biceps tendon surgical reconstruction technique with allograft or autograft usage, to display the normal and abnormal post-operative MRI findings, and to review the clinical outcomes associated with the procedure.
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Affiliation(s)
- Dylan N Greif
- University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, FL, USA.,Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Samuel H Huntley
- University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, FL, USA.,Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Sameer Alidina
- University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Julianne Muñoz
- University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, FL, USA.,Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | | | - Harry G Greditzer
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Jean Jose
- University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, FL, USA. .,Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA. .,Department of Radiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA.
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Kapicioglu M, Bilgin E, Guven N, Pulatkan A, Bilsel K. The Role of Deadlifts in Distal Biceps Brachii Tendon Ruptures: An Alternative Mechanism Described With YouTube Videos. Orthop J Sports Med 2021; 9:2325967121991811. [PMID: 34250167 PMCID: PMC8237209 DOI: 10.1177/2325967121991811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/18/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The classic injury mechanism of a distal biceps brachii tendon rupture (DBBTR) is eccentric loading to the flexed elbow when the forearm is supinated. PURPOSE To determine alternative mechanisms of a DBBTR in powerlifting sports, particularly in deadlift competitions, with the use of YouTube videos. STUDY DESIGN Descriptive epidemiology study. METHODS A search on YouTube was performed using the search terms "distal biceps tendon rupture" and "distal biceps tendon injury" combined with "competition," "deadlift," and "powerlifting." The videos underwent an evaluation for accuracy by 3 surgeons according to predetermined criteria. Type of sports activity, participant sex, side of the injury, and arm positions at the time of the injury were recorded. RESULTS Among the videos reviewed, 35 injuries were found appropriate for an evaluation. All participants were male. The majority of the injuries (n = 25) were observed during the deadlift. Only in 1 deadlift injury were both forearms in supination. In the remaining deadlift injuries (n = 24), all elbows were in extension, with 1 forearm in supination and the other in pronation. Among the deadlift injuries in the mixed-grip position, all ruptures occurred in a supinated extremity: 25% (n = 6) of ruptures occurred on the right side, and 75% (n = 18) of ruptures occurred on the left side; this was a significant difference (P = .014). CONCLUSION We described an alternative mechanism for a DBBTR, namely, eccentric loading to an extended elbow when the forearm is supinated during the deadlift. As all the ruptures occurred in a supinated extremity, holding the bar with both forearms in pronation may prevent or decrease the risk of ruptures during the deadlift.
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Affiliation(s)
- Mehmet Kapicioglu
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | - Emre Bilgin
- Department of Orthopaedics and Traumatology, Tepecik Training and
Research Hospital, Izmir, Turkey
| | - Necip Guven
- Department of Orthopaedics and Traumatology, Van Yuzuncu Yil
University, Van, Turkey
| | - Anil Pulatkan
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | - Kerem Bilsel
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
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Hanlon DP, Mavrophilipos V. The Emergent Evaluation and Treatment of Elbow and Forearm Injuries. Emerg Med Clin North Am 2019; 38:81-102. [PMID: 31757256 DOI: 10.1016/j.emc.2019.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article provides an updated review of the emergent evalution and treatment of elbow and forearm injuries in the emergency department. Clinically necessary imaging is discussed. Common and uncommon injuries of the elbow and forearm are reviewed with an emphasis on early recognition, efficient management, and avoidance of complications. The astute emergency physician will rely on a focused history and precise examination, applied anatomic knowledge, and strong radiographic interpretative skills to avoid missed injuries and complications.
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Affiliation(s)
- Dennis P Hanlon
- Department of Emergency Medicine, Allegheny General Hospital, 320 E. North Avenue, Pittsburgh, PA 15212, USA.
| | - Vasilios Mavrophilipos
- Department of Emergency Medicine, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA
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Simultaneous Ipsilateral Quadriceps and Triceps Tendon Rupture in a Patient with End-Stage Renal Failure. Case Rep Orthop 2018; 2018:7602096. [PMID: 30155330 PMCID: PMC6098857 DOI: 10.1155/2018/7602096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 07/17/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Quadriceps tendon ruptures (QTR) frequently occur in patients with end-stage renal failure, while triceps brachii tendon ruptures (TTR) are less common. This is the first properly documented report of a simultaneous ipsilateral traumatic rupture of both of these tendons. Case Report A 50-year-old patient, on hemodialysis for end-stage renal failure, fell on his right side. He presented with sudden right knee and elbow pain, with functional impairment of both joints. X-rays showed avulsion-like osseous lesions on the olecranon and patella with a low-riding patella. Ultrasound confirmed complete quadriceps and triceps avulsion ruptures. Both lesions were treated surgically. Fixation was performed with anchors using the Krackow suture technique for both tendons. Postoperative clinical and radiological results were satisfactory, and follow-up was uneventful. The patient regained his preinjury functional level with a complete range of motion of both his knee and elbow. Discussion Isolated QTR and TTR are frequent lesions in chronic renal failure patients treated with hemodialysis. Simultaneous ipsilateral rupture of both tendons however is extremely rare and should therefore not be overlooked. Surgical treatment is recommended for complete ruptures.
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Martins WR, Blasczyk JC, Soares S, de Paula WD, Bottaro M, Gentil P. A novel approach for rehabilitation of a triceps tendon rupture: A case report. Phys Ther Sport 2018; 32:194-199. [DOI: 10.1016/j.ptsp.2018.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/17/2018] [Accepted: 05/18/2018] [Indexed: 11/28/2022]
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Beazley JC, Lawrence TM, Drew SJ, Modi CS. Distal Biceps and Triceps Injuries. Open Orthop J 2017; 11:1364-1372. [PMID: 29290876 PMCID: PMC5721327 DOI: 10.2174/1874325001711011364] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 01/26/2023] Open
Abstract
Background: Rupture of the distal biceps and triceps tendons are relatively uncommon injuries typically occurring in middle-aged males as a result of eccentric loading of the tendon. Methods: A literature search was performed and the authors’ personal experiences reported. Results: This review discusses the diagnosis, indications and guidelines for management of these injuries and provides a description of the authors’ preferred operative techniques. Conclusion: Whilst non-operative treatment may be appropriate for patients with low functional demands, surgical management is the preferred option for the majority of patients. We have described a cortical button technique and osseous tunnel technique utilised at our institution for distal biceps and triceps tendon fixation respectively. For biceps or triceps tendon injuries, those receiving an early diagnosis and undergoing surgical intervention, an excellent functional outcome can be expected.
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Affiliation(s)
- James C Beazley
- Coventry and Warwickshire Shoulder and Elbow Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
| | - Thomas M Lawrence
- Coventry and Warwickshire Shoulder and Elbow Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
| | - Steven J Drew
- Coventry and Warwickshire Shoulder and Elbow Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
| | - Chetan S Modi
- Coventry and Warwickshire Shoulder and Elbow Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
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Capo JT, Collins C, Beutel BG, Danna NR, Manigrasso M, Uko LA, Chen LY. Three-dimensional analysis of elbow soft tissue footprints and anatomy. J Shoulder Elbow Surg 2014; 23:1618-23. [PMID: 25037064 DOI: 10.1016/j.jse.2014.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 04/27/2014] [Accepted: 05/04/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tendinous and ligamentous injuries commonly occur in the elbow. This study characterized the location, surface areas, and origin and insertional footprints of major elbow capsuloligamentous and tendinous structures in relation to bony landmarks with the use of a precision 3-dimensional modeling system. METHODS Nine unpaired cadaveric elbow specimens were dissected and mounted on a custom jig. Mapping of the medial collateral ligament (MCL), lateral ulnar collateral ligament (LUCL), triceps, biceps, brachialis, and capsular reflections was then performed with 3-dimensional digitizing technology. The location, surface areas, and footprints of the soft tissues were calculated. RESULTS The MCL had a mean origin (humeral) footprint of 216 mm(2), insertional footprint of 154 mm(2), and surface area of 421 mm(2). The LUCL had a mean origin footprint of 136 mm(2), an insertional footprint of 142 mm(2), and a surface area of 532 mm(2). Of the tendons, the triceps maintained the largest insertional footprint, followed by the brachialis and the biceps (P < .001-.03). The MCL, LUCL, and biceps footprint locations were consistent, with little variability. The surface areas of the anterior (1251 mm(2)) and posterior (1147 mm(2)) capsular reflections were similar (P = .82), and the anterior capsule extended farther proximally. CONCLUSION Restoring the normal anatomy of key elbow capsuloligamentous and tendinous structures is crucial for effective reconstruction after bony or soft tissue trauma. This study provides the upper extremity surgeon with information that may aid in restoring elbow biomechanics and preserving range of motion in these patients.
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Affiliation(s)
- John T Capo
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | - Christopher Collins
- Department of Orthopaedics, University of Medicine and Dentistry of New Jersey-Rutgers, Newark, NJ, USA
| | - Bryan G Beutel
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA.
| | - Natalie R Danna
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | - Michaele Manigrasso
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | - Linda A Uko
- Department of Orthopaedics, University of Medicine and Dentistry of New Jersey-Rutgers, Newark, NJ, USA
| | - Linda Y Chen
- Department of Orthopaedics, University of Medicine and Dentistry of New Jersey-Rutgers, Newark, NJ, USA
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Bibliography—Editors’ selection of current world literature. CURRENT ORTHOPAEDIC PRACTICE 2013. [DOI: 10.1097/bco.0b013e31829d7cd1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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