Distal biceps tendon rupture: Is surgery the best course of treatment? Two case reports

STUDY DESIGN: Repeated case study. INTRODUCTION: Complete rupture of the distal biceps tendon occurs mostly within the middle-aged male population. Surgical repair is traditionally recommended. Given the potential for complications, questions remain whether surgical repair is indicated. PURPOSE: To explore non-operative management for full distal biceps tendon ruptures. CASES: Two participants with complete tears of the distal biceps tendon confirmed with magnetic resonance imaging/ultrasound had chosen to not undergo surgical repair. First, a 48-year-old police officer was an avid weight lifter and recreational athlete. Second, a 43-year-old detailer has minimal physical activity participation other than work duties and light recreational sports. Strength testing was performed immediately after rupture and at 24 weeks after a structured physical therapy program focused on strengthening and stretching the elbow flexors and supinator. OUTCOMES: Initial strength deficits of 17/21% in flexion and 13/19% for supination were detected. In both patients, flexion and supination strength returned to normal limits when compared with the opposite upper extremity. After intervention, functional and disability scores were normal in both cases, and both patients reported return to preinjury repetitive work and weight training. DISCUSSION: Although patients are typically counseled that a reason for surgical repair after biceps rupture is substantial loss of flexion and supination strength, these cases indicate that full recovery of strength and function is possible through rehabilitation. CONCLUSION: These cases question the traditional wisdom that a surgical repair is needed for all distal biceps ruptures. LEVEL OF EVIDENCE: Therapy, level 5. ICD-10 Code: M66.3.