Anatomic repair of the ruptured distal biceps tendon to the radial tuberosity is the treatment of choice. In the absence of complications, the results are universally good, with normal range of motion and restoration of strength.24,25 In repair of acute ruptures, flexion and supination strength generally return completely.4,6,14 However, some studies have shown that repaired nondominant arms have persistent isokinetic deficits of 15% to 50%.20-22 Attachment of the ruptured tendon to the brachialis muscle results in nearly normal return of flexion strength, but can leave as much as a 50% loss of supination strength.6

The senior author (BML) reviewed his last 25 patients (25 injuries) who had a distal biceps tendon rupture repaired by the described technique. Four of the tears were partial. All the patients were men with an average age of 45 years (range, 32 to 61 years). The dominant arm was injured in seven patients (six right and one left arm) and the nondominant arm in eighteen patients (four right and fourteen left arms). The incidence of injury in the nondominant arm was statistically significant (p = 0.003).

TABLE 9.1. Clinical guidelines for rehabilitation of distal biceps tendon repairs

Phase I: Protection and promotion of

Cast immobilization: elbow in 90° of flexion, forearm in supination, wrist in neutral

healing (0 to 3 weeks)

Activity modification: Lifting limited to 5 lb

Maintain uninvolved joint mobility

Phase II: Restoration of motion

Cast removed

(3 to 8-12 weeks)

Hinged elbow brace applied, 30° extension block to full extension; decrease

extension block by 10° per week

Brace is worn at all times except for exercising

A/PROM of wrist, forearm, and elbow

Soft-tissue stretch to tolerance

Aerobic conditioning using lower extremities

Activity modification continues; return-to-work restriction to 5-lb lifting limit

Control swelling and inflammation

Phase III: Restoration of strength and

Hinged elbow brace discontinued

endurance (8 to 16 weeks)

Functional activities progressed to tolerance

Isotonic strengthening; initial biceps curl 5 lb

Isokinetic strengthening for supination and elbow flexion

Upper extremity aerobic conditioning; UBE, rowing

Phase IV: Return to function

Endurance and neuromuscular retraining: controlled to uncontrolled

(4 to 6-9 months)


Work hardening

Return to work

Isokinetic testing

Source: Harris and Dyrek,20 O'Sullivan and Schmitz,21 Seiler et al.,22 Wilk et al.23

Source: Harris and Dyrek,20 O'Sullivan and Schmitz,21 Seiler et al.,22 Wilk et al.23

The time from injury to repair averaged 41.3 days (range, 2 to 330 days). The results of postoperative isokinetic testing varied with arm dominance. Patients whose dominant arm was repaired had normal work production, but had a 6.5% deficit in supination strength and a 12% deficit in flexion strength. Patients whose nondominant arm was repaired had normal work production with their arm in flexion, but a 19% deficit when it was in supination. Patients had no deficit in supination strength of their repaired nondominant arm, but had a 15% deficit in flexion strength. Average pain, subjective weakness, and work or activity limitation were 1.4, 1.2, and 1.2, respectively (1.0, none present; 5.0, extreme pain). The average patient satisfaction was 4.5 on a 5-point scale (5, extremely satisfied). No statistically significant correlation existed with patient age or delay in diagnosis.

Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.

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