distal biceps rupture thomas j kovack do. distal biceps rupture
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Distal Biceps Distal Biceps RuptureRupture
Thomas J Kovack DOThomas J Kovack DO
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Distal Biceps Distal Biceps RuptureRupture
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Normal AnatomyNormal Anatomy
Biceps muscle is responsible for Biceps muscle is responsible for flexing the forearm and supinating flexing the forearm and supinating the forearmthe forearm
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InjuryInjury Rupture most common in active men Rupture most common in active men
between ages of 40 and 60 yrs oldbetween ages of 40 and 60 yrs old Also seen in younger men who are Also seen in younger men who are
weighliftersweighlifters Pre-existing degenerative changes Pre-existing degenerative changes
may predispose tendon to rupturemay predispose tendon to rupture Usually single traumatic event Usually single traumatic event
involving flexion against resistanceinvolving flexion against resistance Patients often report painful tearing Patients often report painful tearing
sensation in front of the elbowsensation in front of the elbow
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InjuryInjury
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InjuryInjury
Patients present with bruising or Patients present with bruising or swelling in the antecubital fossaswelling in the antecubital fossa
Often is a defect where the tendon Often is a defect where the tendon used to insertused to insert
Patients note weakness in elbow Patients note weakness in elbow flexion and forearm supinationflexion and forearm supination
May have pain and cramping of the May have pain and cramping of the biceps musclebiceps muscle
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Treatment Treatment
Can be treated non-operativelyCan be treated non-operatively Patient should expect 30% decrease Patient should expect 30% decrease
in overall flexion strength and 40% in overall flexion strength and 40% decrease in supination strength decrease in supination strength ((MorreyMorrey))
Often can have contiuned cramping Often can have contiuned cramping in the biceps musclein the biceps muscle
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TreatmentTreatment
Decision for surgery:Decision for surgery:
- Surgery allows anatomic re-Surgery allows anatomic re-attachment of tendonattachment of tendon
- After surgery restoration of strength After surgery restoration of strength approaches normal in flexion and approaches normal in flexion and supinationsupination
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SurgerySurgery
Small single incision in front of armSmall single incision in front of arm
Tendon is secured into the radius Tendon is secured into the radius through sutures and anchorsthrough sutures and anchors
Same day surgerySame day surgery
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SurgerySurgery
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SurgerySurgery
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Post-opPost-op
After surgery you are in splint and After surgery you are in splint and sling for first weeksling for first week
Weeks 1-4 are spent in Bledsoe Weeks 1-4 are spent in Bledsoe bracebrace
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Post-opPost-op
Weeks 4 -12 spent working on ROM Weeks 4 -12 spent working on ROM as tolerated but no liftingas tolerated but no lifting
At 3 months can begin biceps curlsAt 3 months can begin biceps curls
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Risks of SurgeryRisks of Surgery
Nerve InjuryNerve Injury Arterial InjuryArterial Injury InfectionInfection Loss of motionLoss of motion Heterotopic ossificationHeterotopic ossification Risks of anesthesia Risks of anesthesia