Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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A Case Series of Symptomatic Distal Biceps Tendinopathy

  • Lee, Jung Hyun (Department of Orthopaedic Surgery, Upper Extremity and Microsurgery Center, Pohang Semyeong Christianity Hospital) ;
  • Kim, Kyung Chul (Department of Orthopaedic Surgery, Upper Extremity and Microsurgery Center, Pohang Semyeong Christianity Hospital) ;
  • Lee, Ji-Ho (Department of Orthopaedic Surgery, Upper Extremity and Microsurgery Center, Pohang Semyeong Christianity Hospital) ;
  • Ahn, Kee Baek (Department of Orthopaedic Surgery, Upper Extremity and Microsurgery Center, Pohang Semyeong Christianity Hospital) ;
  • Rhyou, In Hyeok (Department of Orthopaedic Surgery, Upper Extremity and Microsurgery Center, Pohang Semyeong Christianity Hospital)
  • Received : 2018.06.16
  • Accepted : 2018.09.03
  • Published : 2018.12.01
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Abstract

Background: The study of conservative and surgical treatment of distal biceps tendinopathy and associated biceps tendon partial rupture. Methods: Twenty-one cases with distal biceps tendonitis and partial ruptures were studied who visited Pohang Semyeong Christianity Hospital from June 2010 to August 2017. The mean age was 57.1 years (39-69 years), 14 males and 7 females. The mean duration of symptom at the time of first visit was 4.9 months (0.2-14 months). Ultrasonography and magnetic resonance imaging were performed for patients with severe symptoms. According to the severity of the symptoms, splint immobilization, oral nonsteroidal anti-inflammatory drugs, and ultrasound-guided steroid injection were performed. Surgical treatment was performed if the patient did not respond to conservative treatment for 3 to 6 months or longer. Results: There were 9 cases of partial rupture of the distal biceps tendon associated with distal biceps tendinopathy on imaging studies. Conservative treatment showed symptomatic improvement in 16 of 21 cases. In 4 cases with a relatively mild symptom, anti-inflammatory analgesics and intermittent splinting showed good result. In 12 cases, symptoms improved after ultrasonography-guided steroid injection. Surgical treatment was performed on 5 cases that did not respond to conservative treatment. Conclusions: Conservative treatment of distal biceps tendinopathy may promise good results. However, in case of partial tear of the distal biceps tendon and refractory to conservative treatment, surgical treatment may be needed.

Keywords

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Fig. 1. Magnetic resonance imaging findings of distal biceps tendon. (A) Partial tear: tendon enlargement with abnormal contour, intratendinous signal intensity (arrow). (B) Tendinitis or peritendinous bursitis: abnormal signal intensity around distal biceps tendon (arrow).

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Fig. 2. Anterior approach to distal biceps tendon. (A) The partial tear of the tendon was observed at the distal biceps origin insertion site. (B) Completion of distal biceps tendon tear completion. (C) Debridement and decortication of radial tuberosity. (D) Reattachment with suture anchor.

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Fig. 3. Two incision approach to distal biceps tendon. (A) The partial tear of the tendon was observed at the distal biceps origin insertion site. (B) Tear completion, tendon preparation with fiberwire suture, radial tuberosity decortication. Two drill hole for pullout suture was made. (C) suture pulled out to posterior side of elbow. (D) Biceps tendon reattached anatomically.

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Fig. 4. Treatment options of distal biceps tendinopathy. Of 21 patients, 4 patients (19.0%) showed symptomatic improvement only by medication and splinting, and 12 patients (57.1%) showed improvement after ultrasound (US)-guided steroid injection. The remaining 5 patients (23.8%) required surgical treatment. NSAIDs: nonsteroidal anti-inflammatory drugs.

Table 1. Summary of Patient Demographic, MRI Findings, Treatment, and Outcomes

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Table 2. Pain VAS, Preoperative and Post Treatment

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Table 3. Satisfaction Rating Scale, 6 Months after Specific Treatment

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