Healthy active 50 year-old male recreational ice hockey player presents with chief complaint of acute-onset elbow pain after specific event in which he felt a pop.
History and physical exam are consistent with an acute rupture of the distal biceps tendon with a positive tug test and pain with resisted supination and palpation over the tract of the biceps. X-rays are normal. We reviewed the risks, benefits, and alternatives of surgical repair as well as the post-operative rehabilitation protocol.
Surgical repair is performed with a combined regional and general anesthetic which allows for excellent pain control for the first 12-16 hours after the outpatient procedure. A 4-5 cm incision is made transversely across the proximal forearm in a natural crease overlying the radial tuberosity which is the attachment site of the distal biceps tendon. Great care is taken to identify and protect the lateral antebrachial cutaneous nerve which runs through the surgical field. This single-incision anterior approach allows for stable fixation with excellent function and cosmetic result. A splint or soft dressing is applied for approximately one week and then gentle motion exercises are started with a brace followed by formal physical therapy.
Through careful protection of the repair and hard work in physical therapy, he is able to return to ice hockey with full motion, excellent strength, and optimal restoration of function. As a fellow recreational adult ice hockey player and youth coach, it gives our team great pleasure to see our patients return to what they love.
Distal biceps injuries are relatively common and for young, athletic individuals surgical repair often provides the best results. The biceps is often thought to be an elbow flexor but it is actually a forearm supinator responsible for turning the palm up and doing forceful moves of physical exercise and daily activities such as opening a jar or door.