Biceps Tendon and Triceps Tendon Injuries

Dynamic hinged orthosis following a surgical reattachment and therapy protocol of a distal triceps tendon avulsion

Triceps avulsion injuries are not very common injuries. These authors describe an orthosis and protocol they utilized to successfully treat a client following a triceps avulsion injury. - Victoria Priganc, PhD., OTR, CHT, CLT, Practice Forum Editor.

Bilateral ruptures of the distal biceps brachii tendon

BACKGROUND

The purpose of this study was to identify characteristics associated with bilateral ruptures of the distal biceps tendons.

METHODS

We present a retrospective case series of 25 patients who sustained non-simultaneous bilateral distal biceps brachii tendon ruptures that were repaired surgically, with follow-up available on 10 patients. The average age of the patients was 50 years (range 28-76). All patients were male. The mean time from the first tendon rupture to the contralateral tendon rupture was 2.7 years (range 0.5 - 6.3). Follow-up averaged 45 months (range 24-85).

RESULTS

Patients with bilateral ruptures tended to be middle-aged men, who commonly participated in weight lifting, manual labor, or sports, and who had higher rates of nicotine (50%) and anabolic steroid use (20%) than the general population. After surgical repair of 9 of 10 patients, patients with bilateral distal biceps tendon ruptures had good to excellent outcomes. With the numbers available, outcomes were not statistically associated with manual labor, past medical history, prescription medications, prior tendon injury, body mass index, current activity in sports, use of nutritional supplements, or anabolic steroid use, although worker's compensation claims approached statistical significance (p = 0.059).

CONCLUSIONS

Patients who sustained bilateral distal biceps tendon ruptures tended to be middle-aged men with higher rates of nicotine and anabolic steroid use than the general population.

Management of distal biceps and triceps ruptures

The management of distal biceps and triceps ruptures is reviewed. Epidemiology, clinical presentation, evaluation, surgical management, nonoperative management, and rehabilitation rationale and techniques are presented. Although various surgical repair techniques are used, none has been shown to produce superior clinical outcomes. The literature is lacking information to provide evidence-based decisions regarding rehabilitation strategies. Prospective studies comparing types and timing of repairs and timing and techniques for a postoperative program are needed. As that information is not yet available, the rehabilitation plan outlined in this article is based on timetables for healing tissue, strength of repair, prevention of complications, consideration of patient's medical history and injury history, and review of the literature. Familiarity with the different treatment options assists the surgeon and therapist tailor a therapy program that is optimal for each individual patient.

Ruptured Distal Biceps In Military Personnel

Early operative repair is the currently accepted treatment of distal biceps rupture. However, we describe 6 patients (with 7 ruptures), 5 of whom are in the armed forces with distal biceps tendon ruptures who, as a result of delays in presentation, were treated non-operatively. The subsequent clinical success of these patients (with three excellent, three good and one poor result), has led us to question whether the role of non-operative treatment has been underestimated within the orthopaedic, military and sports medicine literature. The more rapid rehabilitation of conservatively treated ruptures may well have implications for treatment of armed forces personnel.

Early mobilization using dynamic splinting with acute triceps tendon avulsion

Avulsion of the triceps tendon is rare, and no previous report of a completed dynamic splinting rehabilitation plan was found in the literature. A case of a military member and power weightlifter who sustained a triceps tendon avulsion and repair is presented with a six-month follow-up. The rehabilitation program included early active elbow flexion and passive extension using a dynamic elbow splint. The Disabilities of the Arm, Shoulder and Hand (DASH) 1-3 questionnaire was used to monitor the patient's use of his right dominant arm while in the dynamic splint. The DASH scores indicated that he experienced improved use of his affected arm during the splinting period. The end result was a good return of function within 13 weeks and full resumption of work and bodybuilding activities in six months, three months earlier than others reported in the literature who were immobilized after surgery. 4,5.

Return to sport following elbow surgery

Although less common than injuries to the knee or shoulder, elbow injuries can be a substantial challenge to sports medicine providers. Many elbow problems respond to routine nonoperative measures including periods of activity modification and physical therapy, but others may ultimately require surgery. Following surgery, appropriate attention to rehabilitation is important to achieve optimal function. This article addresses some of the more common sports-related operative elbow pathology, basic principals of surgery (with an emphasis on techniques only where it may impact rehabilitation or return-to-sport decisions), and return-to-play decisions (including typical "targeted" time frames). The emphasis is on an understanding of sport-specific functional demands and the difficult assessment of reinjury risk following surgery.