By Dane Johnson
Distal biceps tendon tears are most commonly caused by a forceful eccentric contraction of the biceps causing overloading of the tendon. It is often reported that the elbow is in a more extended position at the time.
These are most common in middle aged men and more often the result is a full rupture of the tendon. Chronic degenerative changes can contribute to parietal or complete tears. Full ruptures can be fairly obvious if the tendon has completely detached allowing the bicep muscle to migrate proximally as shown in the image below.
Pain can be present – however often subsides fairly quickly when it is a full thickness rupture. The patient will generally have noted weakness predominantly on supination (but also on elbow flexion to a lesser extent)
To clinically assess the area we start by observing movement – particularly supination/pronation rotating the palm up and down with the elbow bent to 90 degrees and observing the movement pattern of the biceps and comparing both sides. Patients will be weak with manual resistance testing of supination strength and elbow flexion strength – I generally do this in supination to lessen the assistance of brachialis with this motion.
The hook test is a handy clinical test to perform. You can do this by asking the patient to look at their palm with the shoulder raised and elbow bent to 90 degrees you can hook your finger around an intact distal biceps tendon however, if the tendon is torn, then the ropey tendon is not present.
Radiological confirmation and assessment is crucial for diagnosis if a distal biceps tendon tear is suspected as getting surgical input in a timely manner is important for good outcomes
Conservative treatment is generally only indicated for partial tears of less than 50%.
Surgical intervention involves a repair, either primarily with the existing tendon or with an allograft tendon.
The image you can see here is following a repair and you can see the dark distal bicep button sitting on the posterior radius and just make out the drill hole through which the tendon has been passed to anchor it.
If you are suffering from a distal bicep tendon tear and would like it examined by one of our fully qualified therapists, please call us at Melbourne Hand Therapy today (03) 9899 8490 or leave an enquiry and we will get back to you as soon as possible.