How to identify a ruptured distal biceps

Distal biceps tendon repair and reconstruction Srinivasan, R., Pederson, W., & Morrey, B. Level of Evidence: 5 Follow recommendation: 👍 Type of study: Therapeutic Topic: Biceps tendon rupture - Incidence, surgery and rehabilitation. This narrative review reported on biceps tendon rupture demographics, diagnostic methods, conservative, surgical, and rehabilitative plans. Ninety percent of biceps tendon lesions occur in middle aged males with smoking and large BMI being significant risk factors. The Hook test is 95% sensitive (useful for screening) and 85% specific (useful for confirmation of diagnosis). MRI is the investigation of choice. Conservative management is appropriate for individuals with low functional demands, elbow OA, and significant medical comorbidities. Conservative management often leads to a forearm supination and elbow flexion strength deficits of 40% and 30% respectively. With operative management data suggests that there is limited flexion strength deficit, however, a 10-20% deficit in supination strength is likely to remain. In case of surgical management, the greatest risk for repair failure within the first two weeks. Post-surgical rehabilitation for low tension repairs requires a posterior elbow orthosis at 80° of elbow flexion and forearm neutral position worn 24/7 for 2/52. When the repair is performed under greater tension (repair after 4/52 from injury), the elbow orthosis is transformed into a hinge splint at 2 weeks with a block at 40° of flexion. Every week, the extension restriction is reduced by 10° until reaching 0° of extension at 6/52. After two weeks, the patient is allowed to lift a maximum of 2kg until week 6-10 according to the type of surgery and quality of tissues repair. Following this period, light resistance training can be initiated with a full return to heavy duties by 3-6 months. Complications can include paraesthesia of the radial aspect of the forearm due to a lateral antebrachial cutaneous nerve lesion or wrist/fingers/thumb extension and thumb abduction weakness due to involvement of the posterior interosseus nerve. Clinical Take Home Message: Hand therapists should use the hook test as a screening and diagnostic tool when suspecting biceps tendon rupture. Conservative treatment is an option, however, considering the complications associated with delays in surgical interventions beyond 4/52, it is advisable to refer patients with this condition to a hand surgeon. Post-surgical rehabilitation includes 2/52 full time elbow splinting, followed by range of movement exercises and introduction of light resistance exercises at 6-10/52 according to surgical procedure and quality of tissues repaired. Hand therapists should watch out for motor and sensory deficits following surgery as they are potential adverse events. URL: https://www.jhandsurg.org/article/S0363-5023(19)31469-8/fulltext

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