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Avulsion of Distal Biceps Tendon

  • Usually male
  • Older than 50 
  • Single episode of resisted biceps action
  • If not reattached leads to ~ 60 % reduction in strength of flexion and supination

Treatment
Reattachment; ref: Boyd and Anderson "A method of reinsertion of the distal biceps brachii tendon" JBJS 43A: 1041, 1961

  • 2 incisions
    1. S-shaped anterior incision centred over flexor crease beginning medial and proximal, ending lateral and distal. Locate tendon, insert heavy nonabsorbable suture in distal tendon. Locate the tunnel that the tendon passed in, with a blunt instrument.
    2. Longitudinal incision over posterolateral elbow (aka Boyd), reflect muscle from lateral proximal ulna to expose head and neck of radius. The posterior interosseous nerve is thus protected, pronate the forearm to bring the radial tuberosity into view. Make a trapdoor in the tuberosity and drill 2 holes opposite it. Pass the ends of the suture from anterior to posterior between radius and ulna and pull tendon through, then pass sutures through drill holes, pulling tendon into the trapdoor
  • Post-op: splint for 6 weeks in flexion and supination, then start ROM.

Prognosis

  • Near normal strength and endurance post repair
  • Rare risk of synostosis, with 2 incision approach
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