Distal Biceps Avulsion

CLINICAL FEATURES Almost all cases of distal biceps rupture occur in males, and 80 percent occur in the dominant extremity. A single traumatic event causes acute rupture, resulting in symptoms of pain in the antecubital fossa accompanied by a tearing or popping sensation. Examination will demonstrate tenderness, swelling, ecchymosis, and inability to palpate the biceps tendon in the antecubital fossa. Comparison with the uninjured extremity for asymmetry will aid in making the diagnosis. Deformity in the muscle is palpable as the biceps retract proximally during contraction. The patient can still flex the elbow and supinate the forearm because of intact brachialis and supinator muscles, but strength loss will be much more prominent (40 to 50 percent) than with proximal biceps ruptures. The rupture usually occurs at the tendon-osseous insertion and leaves no distal tendon fragment at the tuberosity. Avulsion fractures are unusual but should be ruled out by radiographs.

DIFFERENTIAL DIAGNOSIS The differential diagnosis includes biceps tendinitis, partial tear, bursitis, anterior capsulitis of the elbow, and annular ligament sprain.

TREATMENT Treatment is surgical tendon repair, and thus orthopedic consultation to plan for timing of repair is warranted. Emergency department treatment consists of ice and analgesia. If the patient is discharged home with plans for later surgical repair, immobilization in a sling and analgesia are standard.

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