Distal Biceps Avulsion

Question 1

Which side do partial biceps tendon ruptures occur most commonly?

Answer 1

Radial side

Question 2

What are physical exam findings of a distal biceps rupture?

Answer 2

1) + hook test if complete avulsion
2) Popeye deformity
3) Weakness with flexion and more so supination (up to 50% loss)

Question 3

How are distal bicep ruptures treated?

Answer 3

1) If low demand and older; conservatively, will lose strength
2) If younger or higher demand; surgical repair

Question 4

What is the most commonly injured structure in the one-incision technique for distal biceps repair?

Answer 4

Lateral antebrachial cutaneous; LABCN pierces the deep fascia of the arm lateral to the musculotendinous junction of the distal biceps tendon and medial to the brachialis muscle

Question 5

What is the most commonly injured structure in the two-incision technique for distal biceps repair?

Answer 5

Lateral antebrachial cutaneous

Question 6

Which technique, one- or two-incision for distal biceps rupture, has less risk of injuring radial (PIN) nerve?

Answer 6

Two-incision

Question 7

How is the arm splinted following a distal biceps repair?

Answer 7

110° of flexion with moderate supination

Question 8

A 42-year-old male has a suspected distal biceps rupture with a tendon that can be palpated but is painful during the hook test examination. What is the most appropriate next step?

Answer 8

MRI to confirm is a partial biceps rupture