distal biceps tendon rupture
- Inzidenz 1,2/100000 pro Jahr
- Männer zw. 40-50j
- conservative management can result in flexion an supination weakness or fatigue
Op Technik: single Incision/Endobutton
anterior approach distal to the antecubital fossa
internervous plane
- distal:
- proximal:
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Does immediate elbow mobilization after distal biceps tendon repair carry the risk of wound
breakdown, failure of repair, or patient dissatisfaction?
James R.A. Smith, MBBS, BSC, MRCS*, Rouin Amirfeyz, MD, MSc, FRCS Bristol Royal Infirmary
Rehabilitation protocols after distal biceps repair are highly variable
Often immobilisation for at least two weeks
The authors report their results using a cortical button technique and immediate postoperative mobilisation
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Methods
retrospectiv
09/2012 – October 2014: 22 distal biceps tendon repairs in 20 patients
OP: cortical button system / activ mobilisation from day of surgery
Physiotherapy
clinical diagnosis: observation of the attitude of the biceps muscle belly, presence of a bruise in the proximal ulnar aspect of the forearm, lack of movement of the bicep with supination, o’driscoll hook test
no routinely mri or xray (prä und postop)
primary outcome: clinical integrity of the tendon at the final follow up
secondary outcome: clinician based an patient reported outcome measures
- ROM elbow, wound complications, neurologic complications
- QuickDASH, Mayo Elbow Perfomance Index, Oxford Elbow Score, Time to work
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Methods
Postoperativ regimen
no brace
aktiv flex/ex an pro/supination from day of operation
wound check after 2 weeks
1kg weight restricion for 6 weeks
review after 8 weeks
sport permitted 12 weeks
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Results
Patient population:
all male; mean age 40,6y
mean time to surgery 17 days
time to return work: 70day (4-179)
mean follow-up 16,6 months (range, 3,8 - 29 months)
All patients had an intact tendon at follow-up
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Results
Movement and patient outcome scores:
99% of the ROM arc of the uninjured elbow
30% mild subjective flexion weakness (not objectively measured)
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Results
Complications
2/3 transient nerve paresthesia
- superficial radial nerve in 6 Patients (27%)
- lateral antebrachial cutaneous nerve in 8 patients (36%)
all nerve palsies had resolved completely by the 8-week follow up
no wound complications
no fixation failures
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Discussion
surgical reattachment of the biceps tendon after rupter is associated with good outcome
Various OP techniques
Gupta et al (8 patients) and Peeters et al (26 patients) : single anterior incision and cortical button device
complication of nerve palsy greater than anticipated
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Discussion
Limitations
small number of patients
absence of comparison group/ no randomization
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Nachbehandlungsschema
Woche 1-6: Pro/Supination frei in 90°, Passiv/aktiv-assistiv ohne Belastung.
Ruhigstellung in der Ellenbogengelenksorthese mit folgenden Bewegungslimiten:
Woche 0-2: 45° Extensionsdefizit aus der Orthese heraus
Woche 2-4: 30° Extensionsdefizit aus der Orthese heraus
Woche 4-6: 20° Extensionsdefizit aus der Orthese heraus
Woche 6: Freigabe der Beweglichkeit ohne Orthese, passive Dehnungsübungen unter physiotherapeutischer Supervision, keine Gewichtsbelastung
Woche 9-12: Erweiterung der Dehnungs- und Bewegungsübungen, Gewichtsbelastung bis 5 kg
Ab Woche 12: Beginn Kräftigungsübungen Schulter/Ellenbogen, Kraftsport frühestens ab Woche 20.
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