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Rupture of distal end of biceps tendon

20 year old young male had pain and weakness in right elbow while working out in Gymnasium. Patient heard a snapping sound from elbow which considered as sprain of elbow. pain continued for few weeks but there was weakness in rotation of forearm subsequently he reported to nearby doctor who advised MRI after which patient was given above elbow slab. MRI was reported as distal biceps rupture with inflammation surrounding area.

Patient was immobilized in above elbow slab for another 3 weeks.  At 5 weeks from injury, patient reported in our out patient department with weakness of flexion and supination. After clinical examination and reviewing MRI films Treatment options were discussed with patient. Patient was keen on continuing very keen on continuing his activities in Gymnasium therefore he  was advised that repair of distal biceps tendon would help him.

two incision technique was planned. first transverse incision given in cubital fossa and ruptured tendon with frayed edges delivered.

when tendon end was delivered it was found to be frayed but was able to reach radial tuberosity therefore there was no graft requirement.

locking nonabsorbable (ethibond #5) sutures were passed through distal end of biceps tendon.

Second small incision given on dorsum of proximal forearm. Radial tuberosity identified and exposed. then window made into cortex of proximal radius with help of burr and bone ends freshened. drill holes were made in opposite cortex distally. sutures were delivered through holes so that distal end of tendon is places in proximal radius.

tendon was fixed to bone with help of endobutton resulting in secure fixation of tendon to bone with maximum tendon to bone contact. this kind of fixation give good chances of bone to tendon healing.

After surgery patient was mobilized in ROM brace. At 6 weeks patient was started on strengthening exercises biceps and at the end of 3 months patient returned to his work out in gymnasium.

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