management of distal biceps injuries in athletes
DESCRIPTION
Bryan L. Reuss, M.D., presents "Management of Distal Biceps Injuries in Athletes" at the 2013 9th Annual Cutting Edge Concepts in Orthopaedics & Sports Medicine Seminar presented by Orlando Orthopaedic Center Foundation.TRANSCRIPT
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Distal Bicep Tendon Ruptures in Athletes
Bryan Reuss, M.D.
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Anatomy
• Bi = two (Latin)
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Function
• Supinator• Assists brachialis with elbow flexion
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Epidemiology
• 1.2 per 100,000 persons per year• Men ages 30-50 usually
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Mechanism
• Rapid, unexpected• Eccentric Load
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Why important?
• Biceps tear results in up to 50% loss of supination
• Up to 40% loss of flexion strength• Significant loss of endurance
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Symptoms
• Pain• Deformity• “Tearing” sensation• Weakness• Ecchymosis
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Exam
• Visual
• Supination pain/strength
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Hook Test
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Diagnostic Imaging
• Xrays (Normal)
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Ultrasound
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MRI
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Treatment
• Nonoperative: Not considered ideal treatment– Deformity– Pain– Loss of strength (sup/flex)– Reserved for sedentary patients/poor medical pts/those
who do not require elbow flex/supination endurance
• Operative– Considered superior (Baker et al, Morrey et al, Chillemi et al)– Gold standard for athletes
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Non-Operative Treatment
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Operative Treatment Techniques
• One-Incision– Interference Screw– Button– Suture Anchor
• Two-Incision– Imbedded in trough
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2- Incision Technique
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One-Incision
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Case Example
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Case Example
• 28-y/o Professional Bodybuilder• Doing pull-ups and felt a “pop”• Immediate deformity and significant pain• Ecchymosis within 48 hours
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Case Example
• Patient chose operative treatment– Weakness– Pain– Deformity– Career
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Other Incision Examples
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Case Example
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My technique
• Mazzocca et al, AJSM, 2007– Tested/compared 4 different techniques– Endobutton, interference screw, bone tunnel, suture anchor– Endobutton: greatest load to failure– Interference screw: least displacement
• I use a hybrid technique with BOTH an interference screw/endobutton– Best of both worlds!
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Post-Op Care/Rehab• Brace for 5-6 weeks (depending on tension)• E. stim, cold therapy, gentle ROM (usually
around 15°/week), wrist/shoulder exercises, scar mobilization
• After 6 weeks: light strengthening, finalize ROM (including sup/pro), grip strength
• After 3 months: finalize strength/endurance
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3 Weeks Post-Op
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Triceps Rupture
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Case Example
• 41-y/o Powerlifter hears “ripping” while doing heavy “skull-crushers”
• Ecchymosis, defect in distal triceps• Severe weakness to elbow extension• Ultrasound in clinic: Triceps Rupture off
olecranon
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Positioning
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Palpable Defect
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The future?
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Thank-You