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A case report of a complicated distal biceps tendon rupture in a senior recreational athlete
ESSKA Academy. Rips L. Nov 8, 2019; 284432; epESMA-21 Topic: Elbow, Wrist and Hand
Dr. Leho Rips
Dr. Leho Rips
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A case report of a complicated distal biceps tendon rupture in a senior recreational athlete

ePoster - epESMA-21

Topic: Sports Trauma

Rips L., Luik M., Koovit T., Rahu M., Kuik R., Kartus J.-T.
Tartu University Hospital, Sports Traumatology Center, Tartu, Estonia

Distal biceps tendon rupture is an uncommon injury. The majority of complications after surgical repair involve nerve injuries and loss of forearm rotation.
A 60 year recreational male athlete sustained a weightlifting trauma on his left arm. Primary surgery was performed using a button system three weeks after trauma. The patient complained of pain and loss of range of motion (ROM) in the elbow joint, numbness of the first three digits on the dorsal side after 2.5 months. X rays revealed heterotopic ossification at the distal biceps insertion site and malplaced hardware. MRI revealed a non-healed distal biceps tendon with proximal migration and large heterotopic ossification. Revision surgery was performed 2 weeks later. The large ossification and hardware were removed. The length of the tendon was sufficient to perform an anatomic fixation to the radial tuberosity. Two 2.8 mm titanium screws with No.2 sutures were used for the fixation of the tendon to the tuberosity of the radius. Postoperative home-based rehabilitation was started 2 weeks after revision surgery.
To present the results after revision surgery of rupture of the distal tendon of the biceps brachii muscle.
Disabilities of the Arm, Shoulder and Hand (DASH) and Visual Analog Scale (VAS) score were evaluated before revision surgery and at 8 months. Triceps brachii and biceps brachii isokinetic strength tests at 60°/s (Humac Norm, USA) were performed at 8 months. X-rays were obtained before the revision surgery and at 1 week and 8 months. ROM of the elbow joint was measured before revision surgery and at 8 months. The rehabilitation guideline aimed to restore ROM, strength and function. Sensory testing was performed before revision surgery and at 8 months.
The DASH score was 75.8 points before revision surgery and 45.8 at 8 months. The work module score were 68.8 and 45.8 and the sports module score were 100 and 80 before revision surgery and at 8 months respectively. The pain (VAS) was 8 before revision and 0 at 8 months. The isokinetic strength deficit was 40% for elbow flexion and 22% for extension compared to the healthy side at 8 months. The ROM deficit was 15° for flexion and 45° for supination before revision surgery. At 8 months a deficit for supination of 15° was found.
In this case report failed primary reconstruction of a distal biceps rupture revealed long term inferior outcomes in a recreational athletes after secondary anatomic reconstruction and supervised rehabilitation.
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