SEARCH RESULTS FOR: distal-biceps-tendon-rupture

distal-biceps-tendon-rupture

Distal Biceps Tendon Rupture: Pathogenesis and clinical findings Authors: Alyssa Federico Reviewers: Tara Shannon, Mehul Gupta, Yan Yu*, Gareth Ryan* * MD at time of publication Aging ↓ Tendon strength from age-related changes in extracellular matrix Male gender Overuse Common in throwing and racquet sports Repetitive microtrauma and inflammation of biceps tendon Corticosteroid and fluoroquinolone use Smoking Hypovascularity Area of hypovascularity between regions supplied by the brachial artery and posterior radial recurrent artery Impaired ability to heal from microtrauma Mechanical impingement Compression of distal biceps tendon by surrounding bone (radial tuberosity, proximal ulna) during forearm pronation Repetitive compressionà tendon degeneration ↑ Involvement in physical labour and hobbies Exact mechanisms remain unclear Impaired cell proliferation Biceps tendon inserts at the radial tuberosity to control forearm supination and flexion Compromised biceps tendon integrity from intra-tendinous collagen degeneration, disorientation, and thinning Sudden eccentric force to flexed elbow (forced lengthening of a contracted bicep muscle)àtension in the distal biceps tendon Biceps muscle cannot contract when distal tendon is detached from insertion site Distal biceps tendon rupture Complete detachment of distal biceps tendon at the attachment site on the radial tuberosity Audible “pop” at time of injury Weak forearm supination and flexion + Ruland biceps squeeze test: Affected elbow held in 60-80° of flexion, with forearm slightly pronated. Distal biceps muscle squeezed by practitioner à forearm does not supinate Local inflammatory response at site of injury Inflammatory response aggravates musculo- cutaneous nerve Pain over rupture site after initial injury Swelling over rupture site Nerve damage (musculocut aneous nerve) during injury Sudden and sharp pain at elbow at initial injury Surrounding blood vessels damaged during injury Blood collects under skin surface Immediate bruising over rupture site Biceps tendon retracts proximally High tension during tendon retraction Fragment of bone torn off from tendon insertion site on radial tuberosity Avulsion fracture of radial tuberosity Connective tissue attachment (aponeurosis) torn during injury Palpable gap between distal end of biceps tendon & radial tuberosity + Hook test: Elbow actively flexed to 90° and forearm supinated. Index finger of examiner cannot be placed beneath distal aspect of biceps tendon (>1 cm deep) Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published April 20, 2022 on www.thecalgaryguide.com