• Clinics in Shoulder and Elbow
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• v.26 no.3
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• pp.222-230
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• 2023

Background: Distal biceps tendon repairs are commonly performed using open techniques. A minimally invasive distal biceps tendon repair technique using a speculum and hooded endoscope was developed to improve visualization, reduce soft-tissue dissection, and minimize complications. This paper describes the technique and reports the outcomes of 75 minimally invasive distal biceps tendon repairs. Methods: The operation reports and outcomes of 75 patients who underwent distal biceps tendon repair using this technique between 2011 and 2021 were retrospectively reviewed. Results: Median time to follow-up was 12 months (interquartile range [IQR], 6-56 months). Primary outcomes were function as measured by the Disabilities of Arm, Shoulder and Hand Score (DASH) questionnaire, and rate of complications. Median DASH score was 1.7 of 100 (IQR, 0-6.8). There were 2 of 75 (2.7%) re-ruptures of the distal tendon. There were no cases of vascular injury, proximal radius fracture, or posterior interosseous nerve, median, or ulnar nerve palsy. Conclusions: In this series, minimally invasive distal biceps repair was safe and effective with a low rate of major complications. Recovery of function, as indicated by low DASH scores, was satisfactory, and inconvenience during recovery was minimized. Level of evidence: IV.

• Clinics in Shoulder and Elbow
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• v.19 no.1
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• pp.48-50
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• 2016

Various tests to help in the clinical diagnosis of distal biceps tendon ruptures have been described. In our experience these tests are painful in the acute setting. We suggest a simple alternative test wherein the biceps muscle belly is held by the examiner and translated medially and laterally. This is done with the forearm flexed to 90 degrees. It is first performed with the biceps relaxed and subsequently performed with the forearm flexed against resistance. In the relaxed forearm the biceps easily translates over 50% of its width. When placed under tension (by flexing against resistance) this translation is significantly reduced. In cases of complete distal biceps tendon rupture, the biceps still translates, even under resisted flexion of the forearm. This simple test is less painful than other described tests, is easy to perform, and aids in clinical diagnosis of distal biceps tendon ruptures.

• Clinics in Shoulder and Elbow
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• v.24 no.2
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• pp.93-97
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• 2021

Background: Injection therapy around the distal biceps tendon insertion is challenging. This therapy may be indicated in patients with a partial distal biceps tendon tear, bicipitoradial bursitis and tendinopathy. The primary goal of this study was to determine the accuracy of manually performed injections without ultrasound guidance around the biceps tendon. Methods: Seven upper limb specialists, two general orthopedic specialists, and three orthopedic surgical residents manually injected a cadaver elbow with acrylic dye using an anterior and a lateral infiltration approach. After infiltration the cadaveric elbows were dissected to determine the location of the acrylic dye. Results: In total, 79% of the injections were localized near the biceps tendon. Of these injections, 20% were localized on the radius near the bicipitoradial bursa. In total, 53% of the performed infiltrations were injected by anterior and 47% by lateral approaches. Of the injections near the distal biceps (79%), 47% were injected by an anterior and 53% by a lateral approach. Of the injections on the radius (20%), 33% were injected by anterior and 67% by lateral approach. Of the inaccurate injections (21%), 75% were injected anterior and 25% lateral. Conclusions: Manual infiltration without ultrasound guidance for distal biceps pathology lacks accuracy. We therefore recommend ultrasound guidance for more accurate infiltration.

• Clinics in Shoulder and Elbow
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• v.26 no.3
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• pp.260-266
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• 2023

Background: Knowledge of the base rate of signal changes consistent with distal biceps tendinopathy on magnetic resonance imaging (MRI) has the potential to influence strategies for diagnosis and treatment of people that present with elbow pain. The aim of this study is to measure the prevalence of distal biceps tendon signal changes on MRIs of the elbow by indication for imaging. Methods: MRI data for 1,306 elbows were retrospectively reviewed for mention of signal change in distal biceps tendon. The reports were sorted by indication. Results: Signal changes consistent with distal biceps tendinopathy were noted in 197 of 1,306 (15%) patients, including 34% of patients with biceps pain, 14% of patients with unspecified pain, and 8% of patients with a specific non-biceps indication. Distal biceps tendon changes noted on radiology reports were associated with older age, male sex, and radiologists with musculoskeletal fellowship training. Conclusions: 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. The accumulation of signal changes with age, also independent of symptoms, suggests that tendon pathology persists after symptoms resolve, that some degree of distal biceps tendinopathy is common in a human lifetime, and that tendinopathy may often be accommodated without seeking care. Level of evidence: IV.

• Clinics in Shoulder and Elbow
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• v.21 no.4
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• pp.213-219
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• 2018

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.

• Clinics in Shoulder and Elbow
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• v.25 no.1
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• pp.36-41
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• 2022

Background: Distal biceps rupture is a relatively uncommon injury that can significantly affect quality of life. Early complications following biceps tendon repair are not well described in the literature. This study utilizes a national surgical database to determine the incidence of and predictors for short-term complications following distal biceps tendon repair. Methods: The American College of Surgeons' National Surgical Quality Improvement Program database was used to identify patients undergoing distal biceps repair between January 1, 2011, and December 31, 2017. Patient demographic variables of sex, age, body mass index, American Society of Anesthesiologists class, functional status, and several comorbidities were collected for each patient, along with 30-day postoperative complications. Binary logistic regression was used to calculate risk ratios for these complications using patient predictor variables. Results: Early postoperative surgical complications (0.5%)-which were mostly infections (0.4%)-and medical complications (0.3%) were rare. A readmission risk factor was diabetes (risk ratio [RR], 4.238; 95% confidence interval [CI], 1.180-15.218). Non-home discharge risk factors were smoking (RR, 3.006; 95% CI, 1.123-8.044) and ≥60 years of age (RR, 4.150; 95% CI, 1.611-10.686). Maleness was protective for medical complications (RR, 0.024; 95% CI, 0.005-0.126). Surgical complication risk factors were obese class II (RR, 4.120; 95% CI, 1.123-15.120), chronic obstructive pulmonary disease (COPD; RR, 21.981; 95% CI, 3.719-129.924), and inpatient surgery (RR, 8.606; 95% CI, 2.266-32.689). Conclusions: Complication rates after distal biceps repair are low. Various patient demographics, medical comorbidities, and surgical factors were all predictive of short-term complications.

• Clinics in Shoulder and Elbow
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• v.26 no.4
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• pp.366-372
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• 2023

Background: There is minimal literature on the morphology of partial distal biceps tendon (DBT) tears. We sought to investigate tear morphology by retrospectively reviewing 3-Tesla magnetic resonance imaging (3T MRI) scans of elbows with partial DBT tears and to propose a basic classification system. Methods: 3T MRI scans of elbows with partial DBT tears were retrospectively reviewed by two experienced observers. Basic demographic data were collected. Tear morphology was recorded including type, presence of retraction (>5 mm), and presence of discrete long-head and short-head tendons at the DBT insertion. Results: For analysis, 44 3T MRI scans of 44 elbows with partial DBT tears were included. There were 9 isolated long-head tears (20%), 13 isolated short-head tears (30%), 2 complete long-head tears with a partial short-head tear (5%), 5 complete short-head tears with a partial long-head tear (11%), and 15 peel-off tears (34%). Retraction was seen in 5 or 44 partial tears (11%), and 13 of the 44 DBTs were bifid tendons at the insertion (30%). Conclusions: Partial DBT tears can be classified into five sub-types: long-head isolated tears, short-head isolated tears, complete long-head tears with partial short-head involvement, complete short-head tears with partial long-head involvement, and peel-off tears. Classification of tears may have implications for operative and non-operative management. Level of evidence: III.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2008.03a
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• pp.165-165
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• 2008

A 27-year-old, right-hand-dominant woman with a posttraumatic anterior shoulder dislocation 3 months earlier after traYc accident presented because of pain and limited range of motion in the right shoulder. On physical examination, the patient had negative instability tests and a sulcus sign. On arthroscopic examination, a bifurcate long biceps tendon with two limbs was observed about 1 cm distal to the origin in the supraglenoid tubercle. We found no evidence of a tear in the long biceps tendon on probing, and the margin of each limb was smooth and round. Although this anatomic variant may be benign, its presence might be associated with other shoulder pathology. It is interesting to speculate whether the aberrant biceps anatomy in our patient contributed to transfer of injury at dislocation to the rotator cuff rather than to the classic anterior-inferior capsulolabral complex. In addition, recognition of the described anatomic variant on arthroscopy can aid the shoulder surgeon in focusing treatment on the actual pathology.

• Clinics in Shoulder and Elbow
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• v.21 no.3
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• pp.158-161
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• 2018

Hereditary multiple exostosis (HME) is an autosomal dominant disorder manifested by the presence of multiple osteochondromas. Although the lesions are benign in nature, exostoses are often associated with characteristic progressive skeletal deformity and displaying clinical symptoms such as mechanical irritation or impingement. We present the successful arthroscopic resection in a 24-year-old HME male with impingement syndrome and long head tendon tear of the biceps caused by osteochondroma arising from the distal clavicle.

• Journal of Korean Orthopaedic Sports Medicine
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• v.8 no.1
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• pp.13-18
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• 2009

Purpose: To report the clinical results of patients treated for a rupture of the distal tendon of biceps brachii Materials and Methods: Between February 1987 and March 2004, we treated 16 patients with a rupture of the distal tendon of biceps brachii. 9 of 16 patients underwent surgical treatment. All cases were male, median age was 26.3(range, 16-48) years. The mean interval between injury and surgery was 4.7 days (range, 1~36 days). Operative correction was performed anatomically, using the two-incision technique(3 cases) or one-incision technique(6 cases). Clinical outcomes were evaluated one year after operation by assessing the review about the physical examination finding and radiologic findings with surgical findings, range of motion, muscle strength, subjective satisfaction, activity and return to previous occupation. and via telephone interview in cases of conservative treatment. Results: In cases of surgical treatment, 85.8%, 86.3% of flexion-extension and supination-pronation motion than healthy side were measured respectively. 75% of flexion power than healthy side was measured. Eight of nine(89%) were very satisfied. Eightl of nine returned to original job. In cases of conservative treatment, 65% of flexion power than pre-injury state was reported. Four of seven were satisfied, two were dissatisfied, one was very dissatisfied. Three of seven returned to original job. Conclusion: Early anatomic reconstruction can restore more strength and endurance for supination and flexion range and power. Conservative management may be considered for partial injuries, but operative repair must be considered in complete rupture, athletes, patient with high activity.