Evolution of Technology

Distal Biceps Tendon Repair

Suspensory cortical buttons are also another option to secure the tendon. These devices function by placing a metallic device through a hole drilled in the radial tuberosity. The metal “button” is secured to the tendon edge by suture and passed through the hole in the radius. Once it reaches the other side of the radius, the “button” is flipped so it cannot pass back through the drill hole, effectively securing the tendon back to the bone.

Studies have shown that this specific type of fixation has the highest load to failure, meaning it can withstand the most force without the repair failing of all repair techniques.

Evolution of Procedure

Distal Biceps Surgery

The key to a successful distal biceps tendon repair is to return the tendon to its native insertion at the biceps tuberosity. There exist multiple options to secure the tendon back to its foot print. Suture anchors are a device that pass suture through the tendon and then secure it to the surface of the bone.

Another option is to drill a hole through the tuberosity, pull the tendon through the hole and then place a screw through the whole over the tendon to prevent it from pulling out. Common complications include damage to the nerve that provides sensation to the lateral forearm and formation of abnormal bone between the radius and ulna which may limit range of motion.

Evolution of Diagnosis

Distal Biceps Rupture

Tears of the distal biceps account for 10% of biceps injuries. The are most commonly seen in men in their 40s after an attempt to contract the muscle with the elbow fully extended. This causes the tendon to tear off from the radius bone where it attaches on the radial tuberosity.

Patients may report hearing a “pop” and will have difficulty flexing the elbow and supinating the forearm. These are typically a degenerative injury, meaning the tendon has sustained repetitive microtrauma over years of life that ultimately weakens it to the point of rupture. While the option to treat these without surgery exists, many healthy and active patients benefit from tendon repair.