Bilateral Distal Biceps Tendon Ruptures

• Published in: The Journal of hand surgery (American ed.) Vol. 37; no. 1; pp. 120 - 123
• Main Authors: Green, Jennifer B., MD, Skaife, Tyler L., MD, Leslie, Bruce M., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2012; Elsevier
• Subjects: Adult; Age Distribution; Aged; Arm Injuries - epidemiology; Arm Injuries - pathology; Arm Injuries - surgery; Biceps; bilateral; Biological and medical sciences; Cohort Studies; Diseases of the osteoarticular system; distal; Female; Follow-Up Studies; Humans; Incidence; Injuries of the limb. Injuries of the spine; Injury Severity Score; Juxtaarticular diseases. Extraarticular rhumatism; Magnetic Resonance Imaging - methods; Male; Medical sciences; Middle Aged; Orthopedic Procedures - methods; Orthopedics; Recovery of Function; Retrospective Studies; Risk Assessment; rupture; Rupture - diagnosis; Rupture - epidemiology; Rupture - surgery; Sex Distribution; tendon; Tendon Injuries - epidemiology; Tendon Injuries - pathology; Tendon Injuries - surgery; Tensile Strength; Traumas. Diseases due to physical agents; tendon; Biceps; distal; incidence; bilateral; rupture; Juxtaarticular disease; Diseases of the osteoarticular system; Bilateral; Epidemiology; Incidence; Biceps muscle; Tendon rupture; Orthopedics; Tissue rupture; Tendon
• ISSN: 0363-5023; 1531-6564
• DOI: 10.1016/j.jhsa.2011.09.043

Purpose To determine the incidence of bilateral distal biceps tendon ruptures. Methods A retrospective review of 321 patients who underwent operative repair of a distal biceps tendon rupture between 1988 and 2010 identified 26 patients with bilateral ruptures. We recorded patient age, mechanism of injury, time between symptom onset before the first surgery and subsequent contralateral symptoms, and time between surgeries. Results Twenty-two bilateral ruptures were confirmed intra-operatively, 3 by MRI, and 1 was lost to follow up. A total of 23 bilateral ruptures (92%) occurred in men. The average age at the initial rupture was 44 years (range, 29–74 y). The average age at subsequent rupture was 48 years (range, 36–79 y). Excluding the 2 women (age 72 and 79 y), the average age at the initial rupture was 42 years and the average age at subsequent rupture was 46 years. The average interval between ruptures was 4.1 years (range, 0.8–13.9 y). The initial rupture occurred in the dominant extremity in 12 cases (50%) and in the nondominant extremity in 10 cases (42%); in 3 patients (8%) the dominance was not documented or ambidextrous. Thirty-three percent were heavy laborers, 3 patients had a smoking history, and 1 patient reported a history of steroid use. Twenty-two patients (88%) had the second side repaired, where we noted that 12 (55%) of the second tendon ruptures were partial tears. Conclusions The 8% cumulative incidence of bilateral biceps tendon ruptures in a consecutive series of biceps tendon repairs may be higher because not all patients were contacted, which introduced a sampling bias. This 8% rate is markedly higher than the reported rate of 1.2 per 100,000 for an isolated distal biceps tendon rupture. This implies that patients with a distal biceps tendon rupture are at risk for a rupture on the contralateral side. Type of study/level of evidence Prognostic III.