Biceps Tendon Ruptures

The biceps brachii muscle has two attachments on the arm: a proximal tendinous attachment on the glenoid and coracoid and a distal tendinous attachment on the radial tuberosity. Both attachments are subject to acute or chronic stress. Disruption of the muscle-tendon-bone interface results in a rupture. Ninety to ninety-seven percent of biceps tendon ruptures occur at the proximal attachment.1 Ruptures at the distal biceps tendon attach ment are considered uncommon. Johnson in1897 and Ac-quaviva in 1898 were the first to describe distal biceps tendon ruptures.2'3 This injury most often occurs in men who are in their fifth or sixth decade of life; however, it can occur in patients at any age after the early twenties.4-6 The muscles in these patients tend to be well developed, but the patients do not need to have the build of a weight lifter to be at risk for rupture. Ruptures can occur in any persons who have reasonably developed muscles in their arms.

The mechanism of injury is an eccentric loading of the biceps muscle that can occur as a result of actions, such as suddenly lifting a heavy load, catching a heavy load, carrying an unbalanced object, or reaching up to prevent a fall. Ruptures also occur following relatively routine activities, such as throwing a football, carrying a large sheet of plywood, or going for a slap shot while playing hockey. The association of biceps tendon ruptures with relatively routine activities suggests that the problem may be due to chronic attritional tears that eventually weaken the distal biceps tendon. Degeneration of the tendon identified at the time of surgery and shreds of tendinous material still attached to the radial tuberosity support this supposition.5'7'8

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