Ruptured Distal Biceps In Military Personnel

Differences in risk factors exist for the occurrence of bilateral versus unilateral distal biceps tendon ruptures: a systematic review

IMPORTANCE

Distal biceps rupture is a debilitating injury that is increasing in incidence. A subset of patient experiences this injury on both sides, simultaneously or at separated times. Previous studies have evaluated the incidence and risk factors of unilateral distal biceps rupture. However, little is known about the risk factors for bilateral distal biceps rupture.

AIMS

This aims of this study were to determine risk factors for bilateral distal biceps rupture and to compare these to the known risk factors for unilateral rupture.

EVIDENCE REVIEW

A systematic review of literature was conducted using five databases, producing a total of 1183 papers. After the review process, 31 papers with data bilateral distal biceps tendon ruptures were included.

FINDINGS

The 31 papers included a total of 2234 patients with 2366 ruptures. Patients with a bilateral rupture were younger than patients with unilateral ruptures (45.8 vs 48.8 years old). Women made up a larger percentage of patients with bilateral ruptures (6.8% vs 4.0%). Bilateral injuries occurred most commonly during heavy lifting or falls, whereas forced extension of the arm was the most frequently reported injury mechanism reported with unilateral ruptures. Tobacco used was more common in patients with bilateral ruptures (24.4% vs 6.8%). Labour-intensive occupations and anabolic steroid use did not appear to increase the risk of a bilateral rupture. Pooling of the data was not possible due to heterogeneity of the included studies.

CONCLUSIONS

While differences in risk factors between patients with unilateral and bilateral ruptures were observed, there was too great of a degree of heterogeneity among the studies to perform a meta-analysis of the data.

LEVEL OF EVIDENCE

Systematic review; level III evidence.

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.

Dynamic supination-flexion splinting for the postoperative management of distal biceps injuries

Distal biceps tendon rupture injuries are traditionally treated with a bulky long arm brace following repair of the tendon. The length of time a patient wears this can vary, depending on the injury. However, the patient is usually in this large brace for 4-8 wks and the elbow angle, for extension, is gradually increased. Supination and pronation are usually in a static neutral position. Fequently patients complain of the brace "migrating, being hot, it is cumbersome, and causes overall arm stiffness". These authors have designed a lighter weight brace that also allows for dynamic supination and flexion of the forearm while healing.

Avulsion of the distal biceps brachii tendon in middle-aged population: is surgical repair advisable? A comparative study of 22 patients treated with either nonoperative management or early anatomical repair

INTRODUCTION

Operative anatomical repair following complete avulsion of the distal biceps brachii tendon in athletic population is usually recommended. However, there is no clear consensus as to the advisability of the operation in middle-aged population. We therefore undertook a study to examine whether early anatomical repair in this specific population is preferable to nonoperative management.

PATIENTS AND METHODS

We evaluated the outcome at a mean of 2 years following this injury in a group of 22 middle-aged active men. Of this group, 12 were managed with early anatomical repair and 10 were managed nonoperatively. Our evaluation included subjective functional outcome scales, isokinetic measurements, and postoperative complication survey.

RESULTS

Although subjective functional assessment demonstrated higher satisfaction in the operated group (p<.05), 9 of the 10 nonoperated patients reported good to excellent outcome as well. Isokinetic evaluation revealed higher performance of elbow flexors and forearm supinators in the group managed operatively (p<.05), while two patients in this group suffered nerve injuries, though both resolved eventually.

DISCUSSION AND CONCLUSIONS

Surgical repair of complete avulsion of the distal biceps brachii tendon in middle-aged active population may be advised to patients, as it achieves superior outcome both subjectively and objectively. However, nonoperative management should be seriously discussed with each patient, as it is expected to result in good to excellent outcome as well, while avoiding potential complications related to the surgery.