gms | German Medical Science

Objectives/Interrogation: Distal biceps tendon avulsions are uncommon and can be treated non-operatively or surgically. Surgical treatment is often requested by people that desire strong supination on their activities. Only a few cases of simultaneous bilateral distal biceps tendon avulsions are published and no consensus exists on the management strategy: staged or simultaneous repair.

Methods: This paper presents two patients with simultaneous bilateral distal biceps avulsions, and brings reviewed literature with only eight cases published. All patients were men, with a mean age of 44 years old. The first case report is a 32 year-old male who heard a pop in both arms associated with acute pain. He was trying to roll a car back over on the road and presented bruise in both forearms and loss of supination power. The hook test was abnormal bilaterally and the patient had a history of anabolic steroid use. Magnetic resonance imaging (MRI) showed bilateral complete distal biceps tendon avulsion and staged surgical procedures were performed. The second case is a 46 years old male subject that presented to the hospital, one week after a painful pop in both elbows during a preacher biceps curl. He had no history of anabolic steroid use and there was marked bilateral proximal biceps migration and a mild bruise in both forearms. The hook test was abnormal bilaterally. MRI showed bilateral complete distal biceps tendon avulsion, and he was submitted to simultaneous repair.

Results and Conclusions: After reviewing the collected published experiences it was found that some articles were based on chronic tears and others had acute lesions, among which half were treated surgically simultaneously and others staged. All of them had satisfactory outcomes, assuming that chronicity of the lesion and the management strategy selected may not interfere in the final result.

One downside of the simultaneous approach is the functional limitation due to initial immobilization. However, some authors demonstrated that immediate elbow mobilization after repair of the distal biceps was not associated with failure. A drawback of the staged approach is the possibility of initiating a heterotopic ossification (HO) cascade as happened with the first case of this paper; therefore a HO prophylaxis might preclude that outcome.

Although a high heterogeneity was found regarding the lesions and its treatment, a simultaneous or a staged approach might be used when operating on these lesions. Both yield satisfactory outcomes.