Pagsira ng Distal Biceps Impormasyon

Ano ang nararamdaman mo

Maaaring maranasan mo ang biglaang matulis na sakit sa harap ng iyong itaas na braso, malapit sa siko. Maraming tao ang naglalarawan nito bilang isang "pop" o "snap". Maaaring makita mo ang paglitaw ng pamumula o pamamaga nang mabilisan. Maaaring magbago itsura ng iyong biceps muscle, madalas ay bumubuo ito nang mas mataas sa iyong braso kaysa sa karaniwan. Nangyayari ito dahil ang tendon na nag-uugnay ng iyong muscle sa iyong buto ay naputol.

Maaaring mapansin mo na mas mahina ang pagtaas ng mga bagay. Ang mga gawaing dati ay madali, ngayon ay mahirap na. Ang pag-ikot ng hawakan ng pinto, pagbubukas ng jar, o pag-angat ng grocery bag ay maaaring maging hindi matatag o masakit. Maaaring mapansin mo na ang pagbaluktot ng iyong siko o pag-ikot ng palad pataas (tulad ng paghawak ng mangkok ng soup) ay partikular na mahirap. Ang partikular na galaw na ito ay nakadepende sa tendon na naputol.

Ang sakit ay madalas na lumala pagkatapos ng aktibidad. Maaaring mas ramdam mo ito sa gabi, lalo na kung subukang matulog sa apektadong gilid. Ang pagpahinga ng iyong braso sa neutral na posisyon ay karaniwang tumutulong upang bawasan ang sakit. Gayunpaman, kahit sa pahinga, maaaring ramdam mo ang mahinang pulso o higpit sa harap ng iyong siko.

Ang mga pang-araw-araw na galaw ay nagiging hamon. Ang pag-abot sa likod ng iyong likod upang isara ang bra o itabi ang shirt ay maaaring hindi komportable. Maaaring iwasan mo ang paggamit ng iyong braso para magdala ng mga bagay upang protektahan ang sugat. Kung hindi pa ka nagsesurgery, maaaring magtanong kung maaari mong pamahalaan ang kahinaan na ito. May mga tao ang pumipili na maghintay, ngunit 36% ng mga pasyente na may hindi naaayos na putol ay sa huli ay nagdesisyon na magkaroon ng surgery. Ito ay dahil ang kahinaan at hindi komportableng pakiramdam ay maaaring magpatuloy at makaapekto sa iyong kalidad ng buhay.

Kung mayroon kang kumpletong putol, madalas na inirerekomenda ang surgery upang ibalik ang lakas. Kung ang putol ay bahagya, maaaring karanasan mo ang maagang rate ng komplikasyon na 20.5% kung ito ay aayusin nang pagsurgery. Gayunpaman, maraming pasyente ang nakakakita na ang hindi pagsurgery na pamamahala ay nagdudulot ng patuloy na hirap sa mga pang-araw-araw na gawain. Ang iyong surgeon ay tutulong sa iyo upang desisyonin kung aling landas ang angkop para sa iyong partikular na sugat at pangangailangan sa estilo ng buhay.

Ano ang nangyayari talaga

Ang biceps muscle ay ang malaking kalamnan sa harap ng iyong itaas na braso. Ito ay nakakabit sa ulirang buto ng iyong forehand sa pamamagitan ng matibay na banda ng tisyu na tinatawag na distal biceps tendon. Isipin ang tendon na ito bilang isang makapal na lubid na humihila sa iyong forehand kapag yumuyuko ka sa siko o ikukutob ang palad pataas.

Ang rupture ay nangyayari kapag ang tendon na ito ay naputol mula sa kanyang punto ng pagkakabit sa buto. Karaniwan itong nangyayari habang nagtatayo ng mabigat o biglaang pagkakaroon ng tensyon. Kapag nangyari ang putol, ang koneksyon sa pagitan ng iyong kalamnan at buto ay nasira. Maaaring marinig mo ang isang pop o mararamdaman ang matinding sakit sa iyong siko o itaas na braso.

Dahil hindi na nakakabit ang tendon, nawawalan ng kakayahan ang iyong braso na gumawa ng malalakas na puwersa sa pag-ikot at pag-yuko. Ito ang dahilan kung bakit maaaring maramdaman mo ang kahinaan kapag sinusubukan mong ikutob ang hawakan ng pinto o itaas ang isang mabigat na kahon. Ang kalamnan ay maaari ring magpukpok pataas sa iyong braso, na lumilikha ng nakikitang buntong hininga na kilala bilang Popeye deformity.

Sa paglipas ng panahon, maaaring subukang ayusin ng katawan ang sarili sa pamamagitan ng pagbuo ng karagdagang buto sa malambot na tisyu sa paligid ng siko. Ito ay tinatawag na heterotopic ossification. Habang ang karagdagang buto na ito ay minsan ay maaaring magdulot ng stiffness, ipinapakita ng mga pag-aaral na ang lakas ng biceps ay madalas na mapapanatili kahit na mangyari ito.

Ang surgical repair ay naglalayong muling ikabit ang tendon sa buto sa pamamagitan ng matibay na anchors o buttons. Ang mga teknik na ito ay dinisenyo upang ibalik ang natural na puwersa ng paghila ng iyong braso. Ang pananaliksik ay nagpapahiwatig na ang mga clinical at functional na resulta isang taon pagkatapos ng repair ay mahusay para sa karamihan ng mga pasyente.

Gayunpaman, ang anumang operasyon ay may mga panganib. Ang distal biceps repair ay may kaugnayan sa 7.5% na major complication rate at 4.5% na reoperation rate. Ang ilang mga pasyente ay nakakaranas ng mga minor na isyu tulad ng pansamantalang numbness o stiffness, na madalas ay naglalaon na lang. Sa kabila ng mga panganib na ito, ang prosedura ay itinuturing na ligtas at epektibo para sa pagpapanumbalik ng function, lalo na sa mga kaso ng kumpletong putol.

Mga maitutulong namin dito

Ang pamamaraan para sa iyong distal biceps rupture ay nakadepende kung ang sugat ay bahagya o kumpleto. Si Dr. Kieran Hirpara, isang upper-limb surgeon sa Mater Private Hospital Rockhampton, ang nagbibigay-direksyon sa aming proseso ng shared decision-making. Inaangkop namin ang plano sa iyong partikular na sugat at pang-araw-araw na pangangailangan.

Para sa mga partial tears, madalas kaming nagsisimula sa non-operative care. Kasama nito ang pagbabago ng aktibidad upang maiwasan ang mabibigat na pagbuhat, physiotherapy upang palakasin ang mga nakapaligid na kalamnan, at paggamit ng splint para sa suporta. Maaari ka ring makatanggap ng injection upang bawasan ang sakit at pamamaga. Layunin ng konservatibong landas na ito na ibalik ang function nang walang operasyon. Ipakikita ng ebidensya na ang nonoperative treatment para sa mga partial tears ay may moderate na success rates na 47%. Madalas na nagbibigay ang injection therapy ng pinakamabilis na ginhawa sa yugtong ito. Mahigpit naming pinagmamasdan ang iyong progreso. Kung mananatili o lumala ang mga sintomas, muling aayusin namin ang plano.

Ang medical management ay nakatuon sa kaginhawaan habang ang iyong tendon ay gumagaling o umaangkop. Maaari kaming magrekomenda ng over-the-counter na gamot sa sakit o anti-inflammatories upang pamahalaan ang hindi komportableng pakiramdam. Maaaring bawasan ng cortisone injections ang pamamaga at sakit sa loob ng limitadong panahon. Ang mga injection ng hyaluronic acid o platelet-rich plasma (PRP) ay minsan ginagamit upang suportahan ang kalusugan ng tisyu, bagaman magkakaiba ang kanilang long-term effects. Hindi naaayos ng mga treatment na ito ang naputol na tendon ngunit tumutulong ito sa pamamahala ng mga sintomas habang nagpaplano ka ng karagdagang hakbang. Ipinapaliwanag namin ang mga posibleng benepisyo at tagal ng epekto ng bawat opsyon upang pumili ka ng angkop sa iyo.

Ang operasyon ay karaniwang isinasaalang-alang para sa mga complete tears o kapag ang konservatibong care ay hindi nagbibigay ng sapat na pagpapabuti. Ang surgical repair ay muling pinag-uugnay ang tendon sa buto, na nagbabalik ng lakas at function. Para sa mga complete tears, ang operasyon ay isang malakas na predictor ng pagpapabuti sa patient-reported outcomes. Gumagamit kami ng mga teknik tulad ng cortical button fixation o suture anchors upang siguraduhin ang pagkakadikit ng tendon. Layunin ng mga paraang ito na ibalik ang anatomic na reattachment site habang binabawasan ang pinsala sa mga nakapaligid na kalamnan. Ang karamihan sa mga pasyente ay bumabalik sa trabaho at sports pagkatapos ng surgical repair. Gayunpaman, dapat mong malaman na isang sa limang pasyente ay nakakaranas ng minor na komplikasyon, at isang sa dalawampu ay nakakaranas ng major na komplikasyon. Kinakailangan ang reoperation sa 4.5% ng mga kaso. Buksan naming ipinapaliwanag ang mga figures na ito upang maging ganap ka ring informed. Mabuti ang toleransya ng early motion pagkatapos ng operasyon at hindi ito tila nagpapataas ng mga adverse outcomes. Gabay namin ka sa isang rehabilitation protocol na nagbalanse ng proteksyon at galaw upang i-optimize ang iyong paggaling.

Ano ang inaasahan

Karamihan sa mga taong nakapagpasurgery para sa putol na tendon ng biceps ay bumabalik sa kanilang karaniwang mga gawain. Inaasahan mong mababawi mo ang halos normal na lakas sa iyong braso para sa pagbaluktot at pag-ikot ng palad pataas. Ang mga klinikal na resulta ay karaniwang mahusay higit sa isang taon pagkatapos ng pagkukumpuni. Totoo ito anuman kung gumagamit ang iyong doktor ng nasisipsip o hindi nasisipsip na turnilyo upang siguraduhin ang tendon.

Ang paggaling ay isang unti-unting proseso. Makikita mo ang pinakamalaking pagbabago sa mga unang linggo pagkatapos ng surgery. Sa paglipas ng panahon, patuloy na magpapabuti ang iyong braso. Ang pinakamataas na antas ng paggaling ay karaniwang umaabot sa plateau sa loob ng isang taon. Sa puntong ito, nananatiling mataas ang mga rate ng kasiyahan. Karamihan sa mga pasyente ay nakakabalik sa trabaho at sa mga isport. Ang average na oras upang bumalik sa trabaho ay bahagyang higit sa 14 linggo. Gayunpaman, maaaring manatili ang ilang natitirang kapansanan kumpara sa iyong batayang lakas.

Kung hindi ka magpapasurgery, iba ang iyong pananaw. Tatlumpu't anim na porsyento ng mga pasyente na may kumpletong o bahagyang sugat na pumipili ng hindi operasyong paggamot ay sa huli ay nagkakaroon ng paglipat sa surgery. Ang mga taong nakapagpapagaling nang walang surgery ay maaaring maranasan ang patuloy na kahinaan. Habang maaaring mapanatili ang lakas ng biceps sa ilang kaso, malinaw ang benepisyo ng pagkukumpuni para sa mga kumpletong sugat.

Dapat mong maging mapagbantay sa mga posibleng komplikasyon. Karaniwan ang mga maliit na komplikasyon. Isang bawat limang pasyente ay magkakaroon ng isang maliit na isyu, tulad ng pinsala sa sensory nerve na karaniwang nawawala sa paglipas ng panahon. Ang mga malalaking komplikasyon ay mas bihira. Ang rate ng malalaking komplikasyon ay nasa pagitan ng 4.6% at 7.5%. Ang rate ng pagkakaroon ng ulit na surgery ay 4.5%. Ang mga protocol ng maagang paggalaw ay madalas na maayos na tinatanggap at hindi nagpapataas ng mga masamang resulta.

Maaaring mag-iba ang iyong personal na landas ng paggaling. Ang mga pasyente sa Workers' compensation ay madalas na mas matagal na bumalik sa trabaho at nag-uulat ng mas mababang mga functional score kumpara sa mga pasyente na hindi sa Workers' compensation. Sa kabila ng mga pagkakaibang ito, ang karamihan sa mga pasyente ay nakakamit ng matagumpay na mga resulta. Inaasahan mong mayroong maunawaan na kurso ng paggaling sa pamamagitan ng maingat na pagsunod sa iyong plano ng rehabilitasyon.

Kailan kumonsulta sa doktor

Kumonsulta sa iyong doktor kung napapansin mo ang patuloy na sakit, kahinaan, o kawalan ng katatagan sa iyong siko na hindi gumagaling kahit magpahinga. Magpakonsulta sa espesyalista kung ang iyong braso ay nakakabit, nawawalan ng lakas, o kung ang mga sintomas ay nakakaapekto sa pagtulog o trabaho. Ang biglaang paglala ng mga isyung ito ay nangangailangan din ng mabilisang pagtutugon. Ang maagang pagsusuri ay tumutulong upang matukoy kung ang operasyon ay angkop para sa iyong partikular na pinsala. Sinusuri ng iyong doktor ang lawak ng sugat upang matulungan kang magdesisyon sa susunod na hakbang.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

Surgical treatment of chronic distal biceps injuries yields favorable objective and subjective outcomes [1].
The short-term clinical influence of biceps complications on shoulder outcome is very limited [2].
The overall frequency of reported complications is higher for single-incision distal biceps repair than for double-incision repair [3].
Surgical repair of distal biceps tendon ruptures has an overall low rate of serious complications regardless of approach or technique [4].
Bioabsorbable interference screw fixation of distal biceps ruptures through a single anterior incision is a safe and successful technique for the management of distal biceps tendon ruptures [7].
Complication rates after distal biceps repair are low [8].
Patients undergoing distal biceps reconstruction with graft augmentation can expect low complications and good functional results [10].
Direct repair in the acute setting is preferred over reconstruction with graft augmentation [10].
Distal biceps repair is associated with a 7.5% major complication rate [12].
Distal biceps repair is associated with a 4.5% reoperation rate [12].

Anatomy & Pathophysiology

Thorough knowledge of distal biceps insertional and footprint anatomy is essential for understanding the biomechanics of rupture and reconstruction, and for avoiding nerve injuries [32].
Distal biceps MRI signal changes consistent with tendinopathy are common in asymptomatic elbows, reducing the probability that symptoms correlate with imaging pathology [29].
Nonoperative management does not restore function to the elbow in cases of chronic biceps tendon rupture [24].
Nonoperative treatment of distal biceps rupture may lead to permanent loss of arm function [50].
Surgical repair of the distal biceps insertion reliably regains both supination and flexion strength in appropriate patients [44].
Distal biceps repair or reconstruction can restore near-normal flexion and supination strength [42].
Surgical repair restores supination strength, although outcomes vary [43].
Operative treatment results in superior elbow and forearm strength and endurance, as well as superior DASH and MEPS scores, compared to nonoperative management [41].
For patients with higher-demand occupations, surgical repair results in a greater likelihood of rating elbow function as much better compared to nonoperative management [26].
Most methods of fixation provide adequate strength to allow early active range of motion, with complications being similar between groups using modern surgical techniques [47].
There is no significant difference in range of motion and strength between different approaches and fixation techniques for distal biceps tendon ruptures [48].
Fixation constructs using an extramedullary cortical button with or without an interference screw, or two intramedullary cortical buttons, demonstrate biomechanical properties comparable to or superior to the native tendon [45].

Classification

Partial distal biceps tendon tears encompass a spectrum of disease with variable presentation and morphology [6].
Isolated short head ruptures are a rare and distinct form of distal biceps tear that present with consistent clinical findings that can aid in diagnosis [11].
The surgical repair of distal biceps tendon ruptures has an overall low rate of serious complications, regardless of approach or technique [13].
The evidence-based diagnostic algorithm using the combination of the Flexion Initiation Test (FIT) and hook test demonstrates high accuracy for the diagnosis of both complete and high-grade partial distal biceps tendon tears [16].
The modified two-incision approach is the current gold standard for distal biceps tendon repairs, though anterior approaches are also effective with similar rerupture rates [20].
The incidence of women sustaining a distal biceps tendon tear is 3.2%, with partial tears being statistically more common than complete ruptures [22].
Anterior single incision techniques were used in the majority of cases in a large cohort study of distal biceps tendon repairs, with varying fixation methods [38].

Clinical Presentation

Chronic distal biceps injuries present with a spectrum of disease where surgical treatment yields favorable objective and subjective outcomes [1].
Biceps-related complications after tenotomy associated with arthroscopic rotator cuff repair have very limited short-term clinical influence on shoulder outcome [2].
Isolated distal biceps femoris injuries occurred primarily via noncontact mechanisms [18].
The prevalence of distal biceps tendon signal changes on MRI in asymptomatic patients is very low [23].

Investigations

Distal biceps MRI signal changes consistent with tendinopathy are common even in asymptomatic elbows, which reduces the probability that symptoms correlate with pathology on imaging [29].

Treatment

Surgical management of chronic distal biceps ruptures demonstrates improvement in outcomes including pain reduction and functional ability [9].
Bioabsorbable interference screw fixation of distal biceps ruptures through a single anterior incision is a safe and successful technique [7].
The early complication rate following partial distal biceps tendon repair was 20.5% [19].
Distal biceps repair is associated with a 7.5% major complication rate and 4.5% reoperation rate [12].
Surgical management of distal biceps tears was a predictor of improved patient-reported outcomes only for patients with complete tears [17].
The results of the meta-analysis showed the superiority of surgical management over the nonoperative approach for distal biceps tendon detachment, with superior flexion and supination strength and better patient-reported outcomes [34].
For patients with higher-demand occupations, surgical repair resulted in a greater likelihood of rating elbow function as much better compared to nonoperative management [26].
Workers' compensation patients who underwent distal biceps tendon repair took longer to return to work and had worse DASH scores than non-workers' compensation patients [40].
Nonoperative management does not restore function to the elbow [24].

Complications

Patients should be counseled that 1 in 5 patients will have a minor complication and 1 in 20 patients will have a major complication after surgery on the distal biceps tendon [21].
Complication rates after distal biceps tendon repair performed by newly trained surgeons were similar to those previously reported in large cohort studies, with nerve injury as the most common complication [25].
This is the largest analysis of complications after distal biceps repair, indicating a major complication rate of 4.6% [31].

Recovery

Direct repair in the acute setting is preferred, but patients undergoing distal biceps reconstruction with graft augmentation can expect low complications and good functional results [10].
The modified two-incision approach is the current gold standard, though anterior approaches are also effective with similar rerupture rates [20].
One in five patients will have a minor complication and one in twenty patients will have a major complication after surgery on the distal biceps tendon [21].
Even in the setting of a distal biceps reconstruction with graft augmentation, patients can expect a similar result to primary repair [27].
The average time to return to work after distal biceps repair in the literature was just beyond 14 weeks [46].
Timing significantly impacts surgical technique selection in distal biceps ruptures, with direct repair favored for acute injuries and high flexion angle repair or allograft reconstruction for chronic cases [51].

Key Evidence

[L1] Surgical treatment of chronic distal biceps injuries yields favorable objective and subjective outcomes. [1] (10.1016/j.xrrt.2022.02.007)
[L3] Nevertheless, the short-term clinical influence of biceps complications on shoulder outcome is very limited. [2] (10.1177/2325967121s00362)
[L1] The overall frequency of reported complications is higher for single-incision distal biceps repair than for double-incision repair. [3] (10.1177/2325967116668137)
[L3] Surgical repair of distal biceps tendon ruptures has an overall low rate of serious complications regardless of approach or technique. [4] (10.1016/j.jse.2017.06.021)
[L5] Partial distal biceps tendon tears encompass a spectrum of disease with variable presentation and morphology. [6] (10.1177/17585732241245054)
[Paper] This is a safe and successful technique for the management of distal biceps tendon ruptures. [7] (10.1007/s00402-009-0974-x)
[L3] Complication rates after distal biceps repair are low. [8] (10.5397/cise.2021.00472)
[L4] Surgical management of chronic distal biceps ruptures demonstrates improvement in outcomes including pain reduction and functional ability. [9] (10.1177/23259671211065772)
[L3] Patients can be consulted that direct repair in the acute setting is preferred; however, even in the setting of a distal biceps reconstruction with graft augmentation, they can expect low complications and good functional results. [10] (10.1016/j.jseint.2020.10.023)
[L4] Isolated short head ruptures are a rare and distinct form of distal biceps tear that present with consistent clinical findings that can aid in diagnosis. [11] (10.1016/j.jse.2020.04.038)
[L3] Distal biceps repair is associated with a 7.5% major complication rate and 4.5% reoperation rate. [12] (10.1016/j.jse.2018.06.028)
[L3] The surgical repair of distal biceps tendon ruptures has an overall low rate of serious complications, regardless of approach or technique. [13] (10.1177/0363546517720200)
[L4] The evidence-based diagnostic algorithm using the combination of the FIT and hook test demonstrates high accuracy for the diagnosis of both complete and high-grade partial distal biceps tendon tears. [16] (10.1016/j.asmr.2021.01.010)
[L2] Surgical management of distal biceps tears was a predictor of improved patient-reported outcomes only for patients with complete tears. [17] (10.1016/j.jhsa.2025.12.027)
[L4] Isolated distal biceps femoris injuries occurred primarily via noncontact mechanisms. [18] (10.1177/2325967118781828)
[L4] The early complication rate following partial distal biceps tendon repair was 20.5%. [19] (10.1016/j.jhsa.2025.04.012)
[L5] This narrative review summarizes the history, anatomy, and controversies surrounding distal biceps tendon ruptures and repairs, highlighting that the modified two-incision approach is the current gold standard, though anterior approaches are also effective with similar rerupture rates. [20] (10.1016/j.jse.2016.05.025)
[L4] Patients should be counseled that 1 in 5 patients will have a minor complication and 1 in 20 patients will have a major complication after surgery on the distal biceps tendon. [21] (10.1016/j.jse.2016.02.032)
[L4] The incidence of women sustaining a distal biceps tendon tear is 3.2%, with partial tears being statistically more common than complete ruptures. [22] (10.1016/j.jse.2014.02.006)
[L3] The prevalence of distal biceps tendon signal changes on MRI in asymptomatic patients is very low. [23] (10.1016/j.jhsa.2022.01.020)
[L5] Nonoperative management does not restore function to the elbow. [24] (10.1007/s11552-013-9551-4)
[L4] Complication rates after distal biceps tendon repair performed by newly trained surgeons were similar to those previously reported in large cohort studies, with nerve injury as the most common complication. [25] (10.1016/j.jse.2022.09.014)
[L4] For patients with higher-demand occupations, surgical repair resulted in greater likelihood of rating elbow function as much better compared to nonoperative management. [26] (10.1016/j.jse.2017.12.010)
[L3] Patients can be consulted that even in the setting of a distal biceps reconstruction with graft augmentation, they can expect a similar result to primary repair. [27] (10.1016/j.jse.2020.01.062)
[L4] The finding that distal biceps MRI signal changes consistent with tendinopathy are common even in asymptomatic elbows reduces the probability that symptoms correlate with pathology on imaging. [29] (10.5397/cise.2023.00164)
[L2] This is the largest analysis of complications after distal biceps repair, indicating a major complication rate of 4.6%. [31] (10.1177/0363546519899933)
[L4] Thorough knowledge of the anatomy is essential for the surgeon in order to understand the biomechanics of rupture and reconstruction of the distal biceps tendon and to avoid injuries of the nerves. [32] (10.1007/s00167-014-3322-9)
[L1] The results of this meta-analysis showed the superiority of surgical management over the nonoperative approach for distal biceps tendon detachment, with superior flexion and supination strength and better patient-reported outcomes. [34] (10.1177/23259671211037311)
[L3] The study examined clinical and surgical outcomes for distal biceps tendon repairs in a large cohort, finding that anterior single incision techniques were used in the majority of cases with varying fixation methods. [38] (10.1016/j.jse.2016.12.053)
[L3] WC patients who underwent distal biceps tendon repair took longer to return to work and had worse DASH scores than non-WC patients. [40] (10.1016/j.jse.2012.11.011)
[L1] Operative treatment resulted in superior elbow and forearm strength and endurance, as well as superior DASH and MEPS scores compared to nonoperative management. [41] (10.1016/j.jse.2021.12.001)
[L5] Distal biceps repair/reconstruction can restore near-normal flexion and supination strength. [42] (10.1016/j.jhsa.2019.09.014)
[L5] Surgical repair restores supination strength, though outcomes vary. [43] (10.1016/j.jhsa.2012.02.008)
[L4] Surgical repair of the distal biceps insertion reliably regains both supination and flexion strength in appropriate patients. [44] (10.5435/00124635-201003000-00003)
[L1] The fixation constructs that consistently demonstrated comparable or better biomechanical properties to native tendon were the extramedullary cortical button with or without interference screw and two intramedullary cortical buttons. [45] (10.1016/j.arthro.2022.08.037)
[L4] The average time to return to work after distal biceps repair in the literature was just beyond 14 weeks. [46] (10.1016/j.jse.2019.12.006)
[L4] Most methods of fixation provide adequate strength to allow early active range of motion, and complications are similar between groups using modern surgical techniques. [47] (10.1016/j.jse.2010.11.009)
[L2] There was no significant difference in range of motion and strength between the different approaches and fixation techniques. [48] (10.1016/j.jse.2015.09.004)
[L4] Nonoperative treatment may lead to a degree of permanent loss of function of the arm. [50] (10.1177/03635465990270020201)
[L3] Timing significantly impacts surgical technique selection in distal biceps tendon ruptures, with direct repair favored for acute injuries and high flexion angle repair or allograft reconstruction for chronic cases. [51] (10.1016/j.jse.2025.07.027)

References

[1] Outcomes and complications after different surgical techniques for the treatment of chronic distal biceps tendon ruptures: a systematic review and quantitative synthesis. JSES Reviews, Reports, and Techniques. 2022. DOI: 10.1016/j.xrrt.2022.02.007

[2] Biceps-related complications after tenotomy associated with arthroscopic rotator cuff repair: risk factors and clinical impact. Orthopaedic Journal of Sports Medicine. 2022. DOI: 10.1177/2325967121s00362

[3] Complications of Distal Biceps Tendon Repair. Orthopaedic Journal of Sports Medicine. 2016. DOI: 10.1177/2325967116668137

[4] Analysis of 784 surgically treated distal biceps tendon ruptures. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2017.06.021

[6] Current concepts in the aetiology, assessment and management of partial distal biceps tendon tears. Shoulder & Elbow. 2024. DOI: 10.1177/17585732241245054

[7] Bioabsorbable interference screw fixation of distal biceps ruptures through a single anterior incision: a single-surgeon case series and review of the literature. Archives of Orthopaedic and Trauma Surgery. 2009. DOI: 10.1007/s00402-009-0974-x

[8] Determining the incidence and risk factors for short-term complications following distal biceps tendon repair. Clinics in Shoulder and Elbow. 2022. DOI: 10.5397/cise.2021.00472

[9] Surgical Results of Chronic Distal Biceps Ruptures: A Systematic Review. Orthopaedic Journal of Sports Medicine. 2022. DOI: 10.1177/23259671211065772

[10] Outcomes of chronic distal biceps reconstruction with tendon grafting: a matched comparison with primary repair. JSES International. 2021. DOI: 10.1016/j.jseint.2020.10.023

[11] Distal biceps short head tears: repair, reconstruction, and systematic review. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.04.038

[12] Major complications after distal biceps tendon repairs: retrospective cohort analysis of 970 cases. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2018.06.028

[13] Surgical Treatment of Distal Biceps Tendon Ruptures: An Analysis of Complications in 784 Surgical Repairs. The American Journal of Sports Medicine. 2017. DOI: 10.1177/0363546517720200

[16] The Flexion Initiation Test and an Evidence‐Based Diagnostic Algorithm for Distal Biceps Tendon Tears. Arthroscopy, Sports Medicine, and Rehabilitation. 2021. DOI: 10.1016/j.asmr.2021.01.010

[17] Thirty-Six Percent Conversion to Surgery Rate for Nonsurgical Treatment of Complete and Partial Distal Biceps Tears. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2025.12.027

[18] Isolated Tearing and Avulsion of the Distal Biceps Femoris Tendon During Sporting Activities: A Systematic Review. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967118781828

[19] Early Postoperative Complications Following Partial Distal Biceps Tendon Surgical Repair. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2025.04.012

[20] Distal biceps tendon history, updates, and controversies: from the closed American Shoulder and Elbow Surgeons meeting—2015. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2016.05.025

[21] Factors associated with adverse events after distal biceps tendon repair or reconstruction. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2016.02.032

[22] Re-rupture rate of primarily repaired distal biceps tendon injuries. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2014.02.006

[23] Evaluation of MRI Signal Changes of the Distal Biceps Tendon in Asymptomatic Patients. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2022.01.020

[24] Treatment of Chronic Biceps Tendon Ruptures. HAND. 2013. DOI: 10.1007/s11552-013-9551-4

[25] Trends and complications of distal biceps tendon repair among American Board of Orthopaedic Surgery part II oral examination candidates. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2022.09.014

[26] Is nonoperative management of partial distal biceps tears really successful?. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2017.12.010

[27] Chronic Distal Biceps Repair with Tendon Grafting: A Matched Comparison to Primary Repair. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.01.062

[29] Prevalence of incidental distal biceps signal changes on magnetic resonance imaging. Clinics in Shoulder and Elbow. 2023. DOI: 10.5397/cise.2023.00164

[31] Complications After Distal Biceps Tendon Repair: A Systematic Review. The American Journal of Sports Medicine. 2020. DOI: 10.1177/0363546519899933

[32] Clinical relevance of distal biceps insertional and footprint anatomy. Knee Surgery, Sports Traumatology, Arthroscopy. 2014. DOI: 10.1007/s00167-014-3322-9

[34] Operative Versus Nonoperative Management for Distal Biceps Brachii Tendon Lesions: A Systematic Review and Meta-analysis. Orthopaedic Journal of Sports Medicine. 2021. DOI: 10.1177/23259671211037311

[38] The distal biceps deficient arm, “the short arc syndrome”. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2016.12.053

[40] Outcomes after distal biceps repair in patients with workers' compensation claims. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2012.11.011

[41] Operative vs. nonoperative treatment of distal biceps ruptures: a systematic review and meta-analysis. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2021.12.001

[42] Distal Biceps Tendon Repair and Reconstruction. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2019.09.014

[43] Repair of Distal Biceps Ruptures. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.02.008

[44] Surgical Treatment of Distal Biceps Rupture. American Academy of Orthopaedic Surgeon. 2010. DOI: 10.5435/00124635-201003000-00003

[45] Two Intramedullary and 1 Extramedullary Cortical Button, With or Without Interference Screw, Show Biomechanical Properties Superior to Native Tendon in Repair of the Distal Biceps Tendon: A Systematic Review and Network Meta‐analysis of Biomechanical Performance. Arthroscopy. 2022. DOI: 10.1016/j.arthro.2022.08.037

[46] Return to work following a distal biceps repair: a systematic review of the literature. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.12.006

[47] Controversies in the surgical treatment of distal biceps tendon ruptures: single versus double-incision repairs. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2010.11.009

[48] Refixation techniques and approaches for distal biceps tendon ruptures: a systematic review of clinical studies. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.09.004

[50] Rupture of the Distal Biceps Tendon. The American Journal of Sports Medicine. 1999. DOI: 10.1177/03635465990270020201

[51] Effect of time from injury to surgery on surgical technique and complication rate in distal biceps tendon repair. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.07.027