Biceps tendon rupture

from Wikipedia, the free encyclopedia
Classification according to ICD-10
S46.1 Injury to the muscle and tendon of the long head of the biceps brachii
S46.2 Injury to the muscle and tendon on other parts of the biceps brachii
ICD-10 online (WHO version 2019)

Biceps tendon tear is the generic term for the tear (rupture) of at least one tendon of the two-headed arm flexor muscle ( Musculus biceps brachii ). A distinction is made between proximal biceps tendon rupture (in the shoulder area) and distal rupture (in the elbow area).

Anatomical conditions

Biceps tendons

The biceps brachii muscle has two heads in the shoulder area, hence the Latin name biceps (two-headed):

  • Caput longum , the tendon of which runs from the tuberculum supraglenoidale - above the actual shoulder joint - through the sulcus intertubercularis. The long head is the primary forearm supinator .
  • Caput breve , the tendon of which originates from the coracoid process (raven-beak process) of the shoulder blade. The short head acts primarily as an elbow flexor.

Both heads combine to form a muscle belly with a tendon in the crook of the elbow, which branches out again shortly afterwards and attaches as a strong main tendon to the mean 22 mm long and 15 mm wide radial tuberosity and as an ancillary tendon over the lacertus fibrosus ( aponeurosis musculi bicipitis ) radiates into the forearm fascia. The distal biceps tendon is 22 mm long and 7 mm thick on average.

The function of the muscle in the elbow area is flexion and supination in the elbow. From a flexion of 90 °, the biceps brachii muscle represents the strongest supinator on the arm (screwdriving). Furthermore, the long biceps tendon has a slightly abducting and internally rotating effect on the shoulder joint , the short head cranializing and adducting . Both together perform an anteversion in the shoulder joint.

causes

The long proximal tendon in the shoulder area is affected in 96% of all biceps tendon ruptures, the distal tendon in the elbow area only in 3% and the short proximal tendon even less often with 1%. In about 80% of the cases, it is the dominant arm.

The long proximal tendon in older people with active shoulders tears as a result of wear and tear. Especially in throwing sports ( baseball ), but also in weight training and golf, the long biceps tendon is increasingly damaged by overload. Previous damage is often held responsible as the main cause of a tear in the long biceps tendon in the event of a sudden trauma , such as a serious fall, but the trauma can also be the sole cause. An avulsion injury to the long biceps tendon also occasionally occurs in combination with a SLAP lesion .

The distal tendon ruptures from sudden direct or indirect trauma. For example, strength athletes or craftsmen can tear their tendons as a result of acute overload. A direct blow or a cut in the crook of the elbow can also induce rupture of the tendons. Concurrent causes may doping measures as induced muscle building hormone-induced damage to the tendon substance or previous cortisone injections work. Treatment with fluoroquinolone antibiotics can also result in a rupture of the biceps tendon. This association was referred to as early as 1995. In smokers, the risk of a tendon rupture is 7.5 times higher.

Previous damage

As with any tendon rupture, the affected tissue can be damaged, which means that the otherwise very stable structure turns out to be intact in everyday use, but no longer has the required stability in the event of sudden force peaks.

Causes of such a weakening can be:

  • Overload damage in exposed areas due to high tensile forces, rubbing against other structures, throwing sports, etc.
  • Ischemia from morphological bottlenecks
  • Degeneration from repeated injections of z. B. Cortisone
  • degenerative diseases of connective tissue , genetic disposition
  • Rheumatic diseases
  • Age

Clinical manifestations

dist. Biceps tendon rupture migrates cranially

Proximal biceps tendon rupture (long biceps tendon)

Source:

  • short-term pain, then relatively painless
  • Weakness in abduction of the shoulder and flexion of the elbow (overall only moderate loss of strength)
  • Creation of a distal swelling or displacement of the muscle belly in the direction of the elbow in muscle contraction

Distal biceps tendon rupture

  • Acute severe pain
  • Whip-cracking sound
  • Functio laesa ( loss of function), flexion and supination in the elbow joint no longer feasible (overall significant loss of strength)
  • Palpable dent in the ruptured area of ​​the tendon, into which blood pours and thus forms a hematoma
  • Development of a proximal swelling or displacement of the muscle belly towards the shoulder with muscle contraction

Investigation methods

MRI of the elbow
  • Anamnesis and clinic compared to the opposite side
  • Sonography
  • X-ray to exclude fractures (proximal tear: shoulder joint in 2 planes, distal tear: elbow in 2 planes)
  • MRI

treatment

Postoperative X-ray after keyhole surgery with rupture of the long biceps tendon. The defect in the cortex of the humerus can be seen well in the form of a keyhole into which the long biceps tendon is hooked with a knot. Drainages are also shown.

In the event of a tear in the long biceps tendon (caput longum) , the effect is less dramatic, as the force can still be guaranteed almost entirely via the caput breve. There is only a loss of strength of approx. 15%. A sign of a rupture of this tendon is the displacement of the muscle belly towards the elbow. The tendon slips down from the joint into the sulcus intertubercularis and grows together there. Refixing the tendon at the upper edge of the shoulder socket does not make sense, as the tendon is degeneratively damaged due to joint changes. Therefore, the tendon rupture is either not treated at all or the tendon is surgically fixed on the upper arm shaft outside the shoulder joint, which can be done either with a screw anchor and tendon suture or with a so-called keyhole technique. The decision about an operative measure or about non-treatment has to be made with the patient: Even if there is no treatment, there is no significant loss of strength, but the cosmetic result with an unsightly Popeye muscle is rather annoying even for older men. This cosmetic problem must be pointed out urgently in the consent discussion.

The flexion function of the biceps brachii muscle in the elbow area is rather subordinate compared to its supination effect , i.e. outward rotation of the forearm. Flexion is sufficiently achieved via the brachialis and brachioradialis muscles . However, the muscle's supination effect is lost due to the distal tendon rupture, and a tendon suture must be performed. The distal (distal) tendon rupture always occurs at the distal bony tendon attachment, so that the tendon suture on the one hand grips the tendon and on the other hand must be fixed to the bone in a stable manner. This fixation on the radius can be done in such a way that the bone is drilled and the tendon sutures are fixed by pulling the sutures through or with the help of a suture anchor (cf. the fixation techniques Achilles tendon rupture , shoulder dislocation ).

After the operation, physiotherapy is essential to restore function, if possible, and to adequately build strength again. After an initial period of rest, during which the tissue is supposed to be reformed, it is initially worked with slight resistance with increasing intensity in order to initiate the reforming of the tissue as functionally as possible and to avoid a contracture of the tissue surrounding the joint.

prevention

The following help avoid previous damage:

  • Warm up before exercising
  • Minimizing or stopping smoking (smoking can cause ischemia and reduces wound healing)
  • Allow injuries and inflammation to heal
  • Taking speed out of movements, continuous build-up of tension

Literature and Sources

  • Michael Schünke among others: General anatomy and movement system. (= Prometheus). Thieme Verlag, Stuttgart 2005, ISBN 3-13-139521-4 .
  • Klaus Buckup: Clinical tests on bones and joints. 3rd, exp. and act. Edition. Thieme Verlag, Stuttgart 2005, ISBN 3-13-100993-4 .
  • Antje Hüter-Becker, Mechthild Dölken (ed.): Physiotherapy in orthopedics. Thieme Verlag, Stuttgart 2015, ISBN 978-3-13-129493-7 .

Web links

Individual evidence

  1. ↑ F. Mehrhoff include: accident assessment . Walter de Gruyter, 2005, ISBN 3-11-017982-2 , p. 231. (online)
  2. ↑ Peter Müller: Retrospective study on the treatment of the distal biceps tendon rupture with refixation at the radial tuberosity using suture anchors via a ventral access. Dissertation . Munich 2009, p. 1, online .
  3. ^ S. S. Burkhart, D. L. Fox: SLAP lesions in association with complete tears of the long head of the biceps tendon: a report of two cases. In: Arthroscopy . 8 (1), 1992, pp. 31-35.
  4. ↑ Chandrakanta Nayak, Barada Prasanna Samal: Quinolone induced tendon rupture: a case series . In: International Surgery Journal . tape 2 , no. 4 , December 14, 2016, ISSN  2349-2902 , p. 725–728 , doi : 10.18203 / 2349-2902.isj20151114 ( ijsurgery.com [accessed March 12, 2018]).
  5. ↑ Lisa A. Merenda, Laure Rutter, Kimberly Curran, Scott H. Kozin: Rupture Following biceps-to-triceps tendon transfer in Adolescents and Young Adults With Spinal Cord Injury: . In: Topics in Spinal Cord Injury Rehabilitation . tape 18 , no. 3 , 2012, ISSN  1082-0744 , p. 197-204 , doi : 10.1310 / sci1803-197 , PMID 23459326 , PMC 3584780 (free full text).
  6. ↑ B. Guérin, G. Grateau, G. Quartier, H. Durand: [Rupture of the long biceps tendon following ingestion of fluoroquinolone] . In: Annales De Medecine Interne . tape 147 , no. 1 , 1996, ISSN  0003-410X , p. 69 , PMID 8763095 .
  7. ↑ More on Fluoroquinolone Antibiotics and Tendon Rupture . In: New England Journal of Medicine . tape 332 , no. 3 , January 19, 1995, ISSN  0028-4793 , p. 193-193 , doi : 10.1056 / nejm199501193320319 , PMID 7800022 .
  8. ↑ Lucas S. McDonald, Christopher B. Dewing, Paul G. Shupe, Matthew T. Provencher: Disorders of the proximal and distal aspects of the biceps muscle. In: The Journal of Bone & Joint Surgery . 2013, Volume 95-AM, Issue 13, July 3, 2013, pp. 1235-1245. doi: 10.2106 / JBJS.L.00221 .
  9. ↑ a b c d Checklist traumatology . 7th edition. Georg Thieme Verlag, Stuttgart 2012, ISBN 978-3-13-598107-9 , doi : 10.1055 / b-002-23575 ( thieme.de [accessed on July 9, 2020]).