School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
Hand and Upper Limb Centre, St. Joseph Hospital, London, ON, Canada.
J Hand Ther. 2021 Jul-Sep;34(3):463-468. doi: 10.1016/j.jht.2020.03.013. Epub 2020 Jun 18.
Repeated case study.
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.
To explore non-operative management for full distal biceps tendon ruptures.
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.
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.
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.
These cases question the traditional wisdom that a surgical repair is needed for all distal biceps ruptures.
Therapy, level 5. ICD-10 Code: M66.3.
重复病例研究。
远端二头肌肌腱完全断裂主要发生在中年男性人群中。传统上推荐手术修复。鉴于潜在的并发症，仍存在疑问，即是否需要手术修复。
探讨完全远端二头肌肌腱断裂的非手术治疗方法。
两名经磁共振成像/超声证实为完全撕裂的远端二头肌肌腱患者选择不进行手术修复。第一位是一名 48 岁的警察，他是一名狂热的举重运动员和业余运动员。第二位是一名 43 岁的detailer，除了工作职责和轻度娱乐性运动外，很少参加体育活动。在破裂后立即和经过 24 周专注于强化肘部屈肌和旋后肌的结构化物理治疗计划后进行了力量测试。
检测到初始屈曲时的力量缺陷为 17/21%，旋后时为 13/19%。在这两个患者中，与对侧上肢相比，屈曲和旋后力量都恢复到正常范围。干预后，两个病例的功能和残疾评分均正常，两名患者均报告恢复到受伤前的重复性工作和举重训练。
尽管患者通常被告知二头肌断裂后手术修复的原因是屈曲和旋后力量显著丧失，但这些病例表明，通过康复可以完全恢复力量和功能。
这些病例质疑了传统的观点，即所有远端二头肌断裂都需要手术修复。
治疗，5 级。ICD-10 编码：M66.3。
