Rupture of the proximal portion of the biceps tendon occurs often when there is a degenerative change within the tendon leading to structure failure. Outcomes and complications after repair of complete distal. The biotenodesis screw and endobutton technique for repair for. Pdf surgical management of acute distal biceps tendon ruptures. Complications of distal biceps repair musculoskeletal key. Andrew green, md associate professor of orthopaedic. If the tendon has completely severed, then surgery may be the patients only option. Chronic distal biceps repair with an achilles allograft. Postoperative complications are rare, but the most common are due to neuropraxia. Pdf distal biceps tendon rupture repair using an endobutton.
Left without surgical repair, however, the injured arm will have a 30% to 40% decrease in strength, mainly in twisting the forearm supination. After surgery, you will require rehabilitation and time to heal. Current repair of a distal biceps tendon rupture has reverted to the single incision technique. Most patients will require narcotic pain medications for short. We present the case of patient who sustained multiple nerve injuries following distal biceps repair. Lateral epicondylitis repair biceps tendon reattachment knee aclpcl repair reconstruction aclpcl patellar bonetendonbone grafts doubletunnel acl reconstruction extracapsular repair. If nerve block was administered, this may give you longer relief. Repair of distal biceps ruptures in active, healthy patients has a high satisfaction rate regardless of technique or approach. Distal biceps repair orthopedic coding ask an expert. Distal biceps tendon repair using the bicepsbutton technique 06. Achilles tendon repair and rehab pdf anterior cruciate ligament more about uw health sports rehabilitation acl rehabilitation.
The combination of the cortical button fixation coupled with an interference screw creates a strong, anatomic repair. Discharge instructions after distal biceps tendon repair. Distal biceps tendon ruptures are treated operatively in active healthy individuals. The elbow is a complex system of three joints formed from three bones. This should be filled and ready for use when you return home from the hospitalsurgery center. The elbow joint is made up of the upper arm bone called the humerus and two forearm bones called the radius and the ulna. Mcl, lcl, and posterior oblique ligament illiotibial band tenodesis patellar tendon repair vmo advancement joint capsule closure hand and wrist collateral. The biceps has two muscle bellies known as the short and long head of biceps. Rehabilitation guidelines for distal bicep tendon repair uw health. Please try to adhere to the below instructions to help assure the best result. It bends flexes the elbow joint and rotates the forearm to a palm up position. Rehabilitation guidelines for distal biceps tendon repair the intent of this protocol is to provide the clinician with a guideline to establish and progress a patient through post operative rehabilitation.
The goal of the rehabilitation is to gradually regain motion in the elbow joint and. Elbow distal biceps tendon repair twin cities orthopedics. Distal biceps tendon repair rehab protocol 1 rehabilitation guidelines distal bicep tendon repair note. The total complication rate after repair of the distal biceps tendon is 15% to 35% and is independent of approach. Distal biceps tendon ruptures are thought to be secondary to an acute forceful eccentric load on a degenerative tendon. The biceps muscle has a tendon that crosses the elbow and attaches to the radius in the forearm. Patients with a distal biceps rupture will have asym. The biceps tendon that attaches to the shoulder is the proximal biceps tendon.
This protocol will vary in length and aggressiveness depending on factors such. With the patient in the supine position and the arm. Distal biceps tendon rupture occurs more often in middleaged male population, involving the dominant arm. Distal triceps tendon repair university orthopedics. The biceps originates from the front of the shoulder blade attaching here via the short and long head of biceps and inserts into the forearm via the distal biceps tendon figure 1. Distal biceps tendon tear is a condition in which the distal biceps tendon i. Romeo explains how the tension slide technique reliably draws the tendon into the radius and the addition of a. Distal bicep tendon repair rehabilitation protocol the intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course for a patient that has undergone a distal biceps tendon repair. A variety of techniques have been described for distal biceps tendon reattachment, including transosseous. Anatomic singleincision repair of distal biceps tendon. Chronic distal biceps repair, single incision, allograft, unicortical button. This protocol was developed for patients who have had a primary repair of the. In some cases, rupture of the biceps tendon can occur.
These two codes are very similar to each other and the few wordings can change the whole scenario. Use ice on the elbow intermittently over the first 48 hours after surgery. Wear splint and dressings until your visit with md one week after surgery. Rehabilitation guidelines distal bicep tendon repair. The pdf of the article you requested follows this cover page. A january 19, 2012 magnetic resonance imaging mri scan revealed a complete tear of the biceps tendon ruptured distally and mild enlargement of the ulnar nerve with cubital tunnel. We also observed that the distal biceps tendon predictably heals to cortical bone, suggesting that the creation of a bone trough in the proximal radius may not be necessary. Biomechanical evaluation of 4 techniques of distal biceps brachii tendon repair article in the american journal of sports medicine 352.
Distal biceps tendon repair protocol this rehabilitation protocol has been developed for the patient following a tenodesis reattachment of the long head of the biceps tendon surgery. Look out for the exact documentation of the report. Rehabilitation guidelines for distal bicep tendon repair. Patient will be fitted with a hinged, limited rom brace lrom preoperatively. Rehabilitation guidelines for distal biceps tendon repair. Distal biceps tendon repair using the bicepsbutton and tensionslide technique allows the surgeon to tension and repair the biceps tendon through a single anterior incision. The biceps muscle lies on the front of the upper arm and has two heads. Distal bicep tendonitis is inflammation around the tendon that can develop over time or with injury. Return to throwing softball rotator cuff repair large to massive. Rehabilitation protocols ohio state sports medicine. Distal bicep tendon repair rehabilitation protocol. Disclosures i have no disclosures relevant to this topic.
Distal biceps tendon ruptures are uncommon injuries responsible for only 3% of all injuries to the biceps tendon. Please follow the protocol along with the instructions listed on the patients referral. Anthony romeo, md, chicago, il discusses an anterior, singleincision approach to distal biceps repair using a bicepsbutton and tension slide technique. Distal biceps tendon repair using a double tension slide. Additional restrictions or modifications will be listed in the last paragraph of the operative report and the therapy instructions.
I am doing a distal biceps repair alone with no other procedures. For most of these cases, unless the patient is elderly or infirm, conservative management should be avoided and the injury should be treated with a surgical procedure to reattach the bicep tendon to the radial tuberosity. Andrew green, md associate professor of orthopaedic surgery chief of shoulder and elbow surgery warren alpert medical school, brown university. Distal biceps tendon repair rehabilitation protocol. Medications local pain medications were used at the time of surgery. Multiple nerve injuries following repair of a distal. In cases of chronic distal biceps ruptures, the combination of muscle atrophy, distal tendon retraction, and fibrosis makes primary anatomic reattachment of the tendon particularly challenging. Week 23 initiate scar management patient is placed in a hinged splint with a dynamic flexion component. Rupture of the distal biceps tendon is a relatively rare injury that may.
Of all biceps injuries, only 3% occur as a rupture or avulsion at the distal insertion. We performed a retrospective cohort study of patients with complete distal biceps tendon rupture that was repaired with cortical button fixation via a 1incision anterior approach. On february 8, 2012 appellant underwent left distal biceps repair under the care of dr. The tendon at the elbow is also called the distal biceps tendon. The biceps tendon at the elbow region is the distal biceps tendon. Anatomic singleincision repair of distal biceps tendon ruptures. Distal biceps tendon repair foundation for orthopaedic.
At the shoulder there are two tendon attachements, where as at the elbow there is one tendon distal attaching to the radius bone of the forearm. Distal bicep tendon repair accelerated rehabilitation protocol the intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course for a patient that has undergone a distal biceps tendon repair. Distal biceps tendon repair rehabilitation protocol michael b. The discharge instructions after distal biceps tendon repair. The intent of this protocol is to provide the clinician with a guideline to establish and progress a patient through post operative rehabilitation.
Distal biceps tendon injuries typically occur in the dominant arm of men in their fourth decade of life. Endobutton technique for repair for acute distal biceps tendon rupture. Distal biceps repair with endobutton rehabilitation protocol week 1 sling for comfort. Pdf failure strengths in distal biceps tendon repair. Pdf distal biceps brachii tendon ruptures are relatively uncommon.
Specific changes in the program will be made by the physician as appropriate for an individual patient. Uw health s sports medicine sports rehabilitation physical therapists and athletic trainers in madison, wisconsin, help injured athletes return to health and return to sport. Biomechanical evaluation of 4 techniques of distal biceps. It is by no means intended to be a substitute for ones clinical decision making. Rehabilitation guidelines after surgery, sports medicine. Revision surgery or cases involving allograft procedures may undergo modifications to the below guideline. These lesions typically occur in a male population aged between the. Distal biceps tendon repair rehabilitation protocol the following protocol should be used as a guideline for rehabilitation progression, but may need to be altered pending the nature and extent of the surgical procedure, healing restraints or patient tolerance.
Uva hand center therapy 415 ray c hunt drive, suite 3200 charlottesville, va 22903 434982hand 4263 biceps tendon repair hep stage 4 week 8 now that you are 8 weeks post operative, your tendon repair is strong enough to allow you to begin gentle rom out. If you have any questions regarding the progress of the patient, the physician should be contacted. Treatment consists of either single or doubleincision techniques. To regain tendon length and avoid flexion contractures, reconstruction with graft augmentation has been proposed as an alternative for cases not amenable to primary repair. Rehabilitation guidelines distal bicep tendon repair note. You will be given a prescription for pain medication at your preoperative appointment. This report described rupture and subsequent repair of the medial head of a bifurcated distal biceps tendon, which had two completely unfused, distinct tendon units and musculotendinous junctions.
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