Functional outcomes and management for distal biceps tendon rupture

Abstract

Although rare, distal biceps tears are common in middle-aged men in their 4th and 5th decades of life. The evidence surrounding prognosis, complications and rehabilitation interventions for distal biceps ruptures are of poor quality and therefore, many questions remain to be answered. This thesis includes four manuscripts describing studies that aim to improve our understanding of the rehabilitation of surgical and non-surgical management of distal biceps tendon rupture, prognostic factors associated with surgical repair and the outcomes for non-surgical management. The first manuscript is a scoping review of rehabilitation procedures described in the literature for the management of distal biceps ruptures. Overall, rehabilitation descriptions for distal biceps ruptures are poor for both post-surgical and non-surgical management. The findings suggest heterogeneity, both on the reporting and the content of rehabilitation delivered as a stand-alone intervention or post-operatively. The second manuscript is a cross-sectional study evaluating potential factors associated with reduced function post double incision surgical repair. The findings suggest that having a smoking history and weaker biceps flexion strength are associated with a poor prognosis and accounted for 50.4% of the variability in functional scores. These findings support existing studies that indicate a smoking history is associated with less favourable pain, function and disability outcomes follow distal biceps repair. The third manuscript is a prospective study evaluating prognostic factors associated with reduced function for those undergoing double incision surgical repair. These findings suggest that the majority of persons undergoing a distal biceps repair using a two-incision approach have minimal complications and good functional outcomes. In addition, having surgery on the non-dominant hand and having a weaker grip strength at baseline accounted for 43.4% of the variability of functional scores. The fourth manuscript describes two cases of non-surgical management of a complete distal biceps rupture. Despite the common belief that surgical repair for biceps rupture results in superior elbow flexion and supination strength, these cases demonstrated that full recover of strength and function is possible through rehabilitation alone. This study contributes to the evidence-base by questioning the need for surgical repair for all cases of distal biceps ruptures.