(11-13,15) Interestingly, all of the studies agree about the footprint of the two distal insertions: the tendon of the long head lies in a more proximal, lateral position and dives deep to a more posterior location on the radial tuberosity to function as the primary supinator.
Regarding operative repair, our patient underwent cortical button fixation through a single incision approach using an anatomic footprint on the radial tuberosity in a slightly distal and anterior position.
Physical exam is remarkable for erythema, swelling and occasionally deformity at the insertion site of the biceps into the radial tuberosity
. An inability for the examiner to hook his or her index finger under the distal biceps tendon insertion is indicative of an abnormal "hook test", which is evidence of complete distal biceps avulsion.
They determined that a watershed area exists approximately 2 cm proximal to the insertion on the radial tuberosity, and that this could predispose to rupture.
Both heads insert distally onto the radial tuberosity. It functions as the primary supinator of the forearm and the secondary flexor of the forearm along with the brachialis.
Early repairs utilized a single anterior incision via the Henry approach to anatomically reattach the distal biceps to the radial tuberosity
via drill holes.
The distal biceps tendon rotates 90[degrees] externally before inserting onto the posterior ulnar aspect of the radial tuberosity. The insertion is centered 30[degrees] anterior to the coronal plane with the arm fully supinated.
A case report involving a ruptured bifurcated distal biceps tendon has sparked recent interest in better defining the anatomy of the biceps insertion into the radial tuberosity. (7) In one cadaveric study, two distinct parts of the distal biceps tendon were identified in 10 of 17 specimens, each corresponding to the long and short heads of the muscle.
Magnetic resonance image (MRI) examination of both elbows revealed avulsion of the biceps tendon from the radial tuberosity, with approximately 2 cm of retraction in the right elbow (Fig.
The right distal biceps tendon was repaired primarily to the radial tuberosity at 7 weeks following the injury utilizing a modified Boyd-Anderson approach.