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      Distal Biceps and Triceps Injuries

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          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.


          A literature search was performed and the authors’ personal experiences reported.


          This review discusses the diagnosis, indications and guidelines for management of these injuries and provides a description of the authors’ preferred operative techniques.


          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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          Most cited references 36

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          Distal biceps tendon ruptures: incidence, demographics, and the effect of smoking.

          The purpose of the current study was to determine the incidence of distal biceps tendon ruptures within a defined population, to describe the demographics of affected individuals, and to identify potential risk factors. The healthcare system in this study provides care to a known number of members in an area defined by zip codes and proximity to the medical center. Medical records for all members who presented with injuries about the elbow during a 5-year period were reviewed. Thirteen men and one woman with an average age of 47 years comprised the study population. The dominant extremity was involved in 86% of patients. All patients described a mechanism involving excessive eccentric tension as the arm was forced from a flexed position. The incidence of injury in the membership population averaged 1.2 ruptures per 100,000 patients per year. Forty-three percent reported regular tobacco use, whereas only 9% of all members were smokers. A Poisson regression analysis revealed a 7.5 times greater risk of distal biceps tendon rupture in patients who smoke. The incidence of distal biceps tendon ruptures is 1.2 per 100,000 patients, with the majority in the dominant elbow of men who smoke and who are in their fourth decade of life.
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            Rupture of the distal tendon of the biceps brachii. A biomechanical study.

            In biomechanical studies on ten patients who had had a rupture of the distal tendon of the biceps brachii, we compared the results of immediate anatomical reattachment, delayed reattachment, and conservative treatment. When the tendon was simply attached to the brachialis muscle (one patient), there was nearly normal strength in elbow flexion but about 50 per cent loss of forearm supination. Late reinsertion (one patient) improved strength of both flexion and supination, but not to normal. Immediate reattachment (four patients) restored normal strength in flexion and supination at one year but not at four months (one patient). With conservative treatment (three patients) there was a mean loss of 40 per cent of supination strength and variable loss of flexion strength, averaging 30 per cent. These data suggest that immediate surgical reinsertion of the biceps tendon into the radial tuberosity, compared with other modes of treatment, restores more strength of flexion and supination.
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              Rupture of the distal tendon of the biceps brachii. Operative versus non-operative treatment.

              We did Cybex testing of thirteen patients who had had a rupture of the distal tendon of the biceps brachii. The tests were performed fifteen months to six years after injury. The ten patients who had had a surgical repair through the two-incision technique showed a return to normal levels of strength and endurance with regard to both flexion of the elbow and supination of the forearm. The three patients who had had conservative treatment showed a remaining deficit in those parameters which was clinically evident in several activities, such as use of a screwdriver or baseball bat.

                Author and article information

                Open Orthop J
                Open Orthop J
                The Open Orthopaedics Journal
                Bentham Open
                30 November 2017
                : 11
                : 1364-1372
                Coventry and Warwickshire Shoulder and Elbow Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
                Author notes
                [* ]Address correspondence to this author at the Coventry and Warwickshire Shoulder and Elbow Unit, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK; Tel: 02476 965094; E-mail: jamescsbeazley@
                © 2017 Beazley et al .

                This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Suppl-8, M4


                tendon rupture, reconstruction, elbow joint, distal triceps, distal biceps


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