The biceps muscle of the upper arm is the muscle the cartoon character Popeye was always flexing to show his strength after eating a can of spinach. This muscle has an important role in bending the elbow. Ruptures of the biceps tendon at the elbow can be very disabling and often require surgical repair or reconstruction.
In this review article, hand surgeons from the University of Pittsburg Department of Upper Extremity Reconstructive Surgery provide an update on this problem. The “new news” about distal biceps tendon injuries has come about for three reasons:
1) Technology has made it possible to discover new understanding about the biceps tendon anatomic form and function.
2) Thirty years of improvements have been made on surgical techniques to reduce complications following surgery and to improve strength of the repair (referred to as tendon-to-bone fixation).
3) Studies over the last 30 years (since the mid-1980s) have given us enough data to see long-term results of both conservative (nonoperative) care and surgical management.
Form and function (mentioned in number one above) refers to the structure of the biceps tendon, “footprint” (where and how it attaches to the bone), and biomechanics (how it contracts and relaxes to create movement). Data mentioned in number three above has been collected on both acute and chronic injuries as well as partial and complete tears of the distal biceps tendon.
Through a series of illustrations, photos, and imaging studies (MRIs, X-rays), the authors bring us up-to-date on the basic science of biceps tendon, repair biology (how it heals), and the diagnosis of partial versus complete tears. The same approach is used to describe current methods of treatment. Here are a few highlights of new findings that may be of interest to surgeons:
In addition to the details listed above, the reader will find information in this article about complications, complication rates, advice regarding surgical techniques, and pros and cons of conservative care versus surgical intervention. Summaries of treatment results from past studies on this topic of distal biceps tendon injuries and treatment are also provided.