Is There A Time Limit On Having A Bicept Tear Surgically Repaired?
Int J Sports Phys Ther. 2022 Dec; 7(6): 663–671.
REHABILITATION OF A SURGICALLY REPAIRED RUPTURE OF THE DISTAL BICEPS TENDON IN AN Active Centre AGED MALE: A Example REPORT
Aaron Horschig
1Boost Concrete Therapy and Sport Operation, Kansas City, Missouri, USA
Stephen P. Sayers
2Academy of Missouri, Columbia, Missouri, The states
Tom LaFontaine
3Optimus: The Center for Wellness, Columbia, Missouri, United states of america
Scott Scheussler
4Physical Therapy Spine & Sports Medicine, Ballwin, Missouri, USA
Abstruse
Background:
Complete rupture of the distal tendon of the biceps brachii is relatively rare and there is petty information to guide therapists in rehabilitation afterwards this injury. The purposes of this case written report are to review the rehabilitation concepts used for treating such an injury, and talk over how to change exercises during rehabilitation based on patient progression while adhering to md recommended guidelines and standard treatment protocols.
Case Presentation:
The patient was an active 38‐year old male experienced in weight‐training. He presented with a surgically repaired right distal biceps tendon following an accident on a trampoline adjusted with a bungee suspension harness. The intervention focused on restoring range of motility and strengthening of the supporting muscles of the upper extremity without placing undue stress on the biceps brachii.
Outcomes:
The patient was able to progress from a moderate brake in ROM to total AROM 2 weeks ahead of the physician's mail service‐operative orders and initiate a re‐strengthening protocol by the eighth week of rehabilitation. At the eighth post‐operative week the patient reported no deficits in functional abilities throughout his normal daily activities with his affected upper extremity.
Discussion:
The results of this example report strengthen current knowledge regarding concrete therapy treatment for a distal biceps tendon repair while at the same time providing new insights for future protocol considerations in active individuals. Most current protocols do not advocate ambitious stretching, AROM, or strengthening of a surgically repaired biceps tendon early in the rehabilitation process due to the fear of a re‐rupture. In the opinion of the authors, if total AROM can be accomplished before the 6thursday week of rehabilitation, initiating a slow transition into light strengthening of the biceps brachii may be possible.
Level of evidence:
4‐Single Case report
Keywords: Distal biceps tendon surgical repair, rehabilitation guidelines
BACKGROUND AND PURPOSE
Complete rupture of the distal tendon of the biceps brachii is relatively rare and there is little information to guide therapists in rehabilitation afterwards this injury and subsequent surgical repair. A regimented physical rehabilitation program of resistance training and stretching is warranted for patients who sustain a distal biceps tendon rupture and undergo surgical reattachment of the tendon. In the opinion of the authors, such a protocol may be effective in promoting full recovery and return to functional and athletic activities.
Complete rupture of the distal biceps brachii accounts for approximately 3% of all biceps ruptures (the long caput ruptures account for 96% and the short head 1%).ane The loss of function from a distal biceps tendon rupture is substantial secondary to the total loss of torque produced past the biceps brachii resulting in decreased strength in elbow flexion and supination, and recovery can exist slow.ii Therapists and other exercise professionals demand to exist aware of the best practices following this injury. The most common mechanism of injury is a single unanticipated load placed on the elbow joint while in a flexed position.2 An aural "popular" is usually heard followed by an visually observable abnormal contour of the upper arm.3 In almost all cases, conservative treatment without surgical reattachment of the distal tendon to the radial tuberosity has been shown to leave patients with markedly decreased muscular strength and endurance of forearm supination and elbow flexion.4,5 Therefore, firsthand surgical repair is the recommended course of action. Even so delayed surgical treatment (3 weeks to five months afterwards diagnosis) has been shown to be equally beneficial in long term follow‐up results when compared to patients treated early (within 8 days of initial injury).6
The biceps brachii is the main flexor at the elbow joint and a powerful supinator when the elbow is in a flexed position.vii It as well aids with shoulder flexion, stabilization of the humeral head during deltoid contraction, and tin can assistance in abduction and internal rotation of the humerus.7 Proximally, the long head of the biceps originates at the supraglenoid tubercle of the scapula and the short head from the coracoid process of the scapula.vii Distally, the biceps inserts on the radial tuberosity and via the bicipital aponeurosis (Figure 1).12
Anatomy of the biceps brachii. Annotation the distal attachment to the radial head via the biciptial aponeurosis. Used with permission from The Journal of Mitt Surgery.
The two types of surgical procedures commonly used are the single‐incision technique and the double‐incision technique (Figures 2 and 3).8,ix Numerous studies accept been performed examining the different methods of surgical repair of the distal biceps brachii tendon tear as well equally long term results of operative vs. non‐operative treatments in terms of force and range of move (ROM) recovery.2,ix,ten Younger patients with higher activity levels demonstrate improved recovery of ROM as compared to like injuries sustained by those in an elderly population, nonetheless in that location is limited information bachelor to guide therapists and other exercise professionals with regard to strengthening of the muscle post‐surgery.5,6 In early rehabilitation, strengthening exercises (which stress the suture anchor) have usually been prohibited due to fear of re‐rupturing the tendon. Although new surgical techniques are existence adult that have demonstrated the ability for surgically repaired tendons to withstand higher loads prior to failure, recommendations for the introduction of strengthening exercises mail‐surgery accept non been modified to reflect these surgical advances.11 For example, Heinzelmann et al recently found that repair of a distal biceps tendon rupture with use of a soft tissue button and interference screw technique through a limited anterior incision can allow for a greater repair force, thus allowing for earlier aggressive rehabilitation such equally a progression to low-cal hurting‐free strengthening at only 2 weeks postoperative.12
Unmarried‐incision technique for distal biceps tendon repair. Used with permission from The Periodical of Shoulder and Elbow Surgery.
Double‐incision technique for distal biceps tendon repair. Used with permission from The Elbow and Its Disorders. Copyright Elsevier (2000).
Rehabilitation of a surgically repaired distal biceps tendon typically follows two phases: first immobilization, either with a cast or hinged caryatid, in club to limit full motion for the outset 6 postoperative weeks, and a second phase that focuses on strengthening the atrophied muscles and eventual render to functional activities.3 In a retrospective review of 113 patients who underwent therapy for distal biceps repairs, Cheung et al reported that by increasing ROM through the use of a hinged caryatid with an extension brake originally set up at 60° of flexion and decreasing 20° every two weeks, total extension was achieved past week six, with strengthening of the biceps starting during the 8th week.xiii More than conservative treatment protocols have documented placing the injured extremity in a cast for six weeks, with restrictions on active stretching even at the 12thursday mail service‐operative week, and a strengthening phase initiated only at the 16th postal service‐operative week.3 There is little data on more ambitious rehabilitation protocols for this type of surgery. The descriptions of the treatments described in this case report may help guide concrete therapists in the rehabilitation of a patient with a ruptured distal biceps brachii tendon that has been surgically repaired.
The purposes of this case report are to: 1) present the rehabilitation protocol used with an individual with a surgically repaired ruptured distal biceps tendon, two) review the rehabilitation concepts used for developing the protocol for treating such an injury, and iii) discuss how to modify exercises during the rehabilitation process based on patient progression while still adhering to the doc recommended guidelines.
Case Clarification: Patient History
The patient was an active, 38‐year old male person who participated regularly in resistance training. He underwent surgical repair of the right distal biceps tendon post-obit an accident on a trampoline adapted with a bungee pause harness. While in the ascending phase of his jump, the patient held on too tightly to the trampoline bungee cords attached to the harness causing his right upper extremity to forcibly abduct resulting in an extension torque at his elbow joint confronting the elbow existence held in flexion. This machinery of injury resulted in a eccentric overload on the distal biceps muscle tendon causing it to tear away from the insertion at the radial tuberosity. The patient described hearing a "popping" sound followed by sudden sharp and severe pain. Magnetic resonance imaging (MRI) of the upper extremity revealed consummate rupture of the distal biceps brachii. Surgery was performed 15 days after the initial injury using a single‐incision technique. Informed consent was given by the patient to exist presented in this publication
Clinical Impression #1
Prior to the injury the patient was highly active, participating in resistance training practise four‐5 times a week. Following the injury, his goal was to return to his previous practise schedule. Based on his history, machinery of injury, and the level of invasiveness with the surgical process to reattach the biceps tendon, the authors predictable that he might ‐demonstrate severe limitations in elbow joint ROM accompanied with high levels of pain. Based on subsequent observations, the initial plan for test included cess of ROM and hurting levels with a verbal numeric rating calibration (NRS) and no manual muscle testing (MMT) per dr. orders.
Test
The patient presented with the right upper extremity in a brace, locked at ninety° of elbow flexion (Figure iv).14 Physician orders at the fourth dimension called for no active flexion of the elbow or supination at the forearm. Review of the patient's history indicated no previous musculoskeletal injuries to the upper extremities and no major cardiopulmonary, integumentary, neuromuscular, or other medical bug that might impede recovery or participation in rehabilitation. Physical examination of the injured region revealed a visible and palpable deformity of the biceps brachii muscle abdomen, primarily in the distal region, with a small scar in the right antecubital fossa where the biceps tendon had been surgically reattached. The scar was approximately three cm in length and was healing well without any signs of infection.
Immobilization hinged caryatid for the elbow articulation. Specific brace shown is a Mackie Elbow Brace. Photograph used with permission from Ortho Innovations.
Active range of motion (AROM) was assessed bilaterally with a standard (universal) goniometer.15 AROM of the correct (involved) elbow articulation into flexion and extension revealed dramatic decreases when compared to the contralateral side, with pain of 3/10 reported using the NRS that occurred at the end of his range of movement (Table one).16,17 At the time of the initial evaluation, no MMT's were performed due to md prescribed precautions. Elbow joint mobility presented with major restrictions. A restricted end‐feel was establish with arthrokinematic assessment in the humeroulnar, humeroradial, superior radioulnar and inferior radioulnar motions.
Tabular array one.
Initial evaluation measurements. Note all measurements are active range
| Motion | Right Upper Extremity | Left Upper Extremity |
|---|---|---|
| Flexion | 130 deg | 150 deg |
| Extension | 35 deg flexion | Odeg |
| Supination | 85 deg | xc deg |
| Pronation | 50 deg | 90 deg |
Clinical Impression #2
Based on the physical examination, pervious level of functioning and past literature bear witness it was evident hypothesized that if full AROM could exist regained the patient would have minimal difficulties in returning to his previous level of activity including heavy resistance training. Per physician orders, exercises that actively contracted the biceps muscle were prohibited until the eighth week of rehabilitation.
Intervention
Initially interventions were focused on restoring range of motion using PROM, stretching, and grades three and iv joint mobilizations, forth with devising exercises to strengthen supporting scapular stabilizing muscles of the upper extremity without placing undue stress on the biceps brachii. (Figure five) Range of motion was assessed actively and passively every one to ii weeks.
Suggested rehabilitation program protocol for distal biceps repair. Note the protocol includes specific phases of rehabilitation starting from the acute post‐surgery stage, extending to the render‐to‐play menstruum.
After the showtime 2 weeks of physical therapy the patient reported no increase in soreness. Appendix 1 presents the rehabilitation protocol used with this patient. He also was compliant with a home practise program (HEP) of AROM exercises of the elbow, shoulder, and forearm similar to those performed in the clinic. Exercises were to be performed at domicile in all planes of movement for 3 sets of twenty repetitions to end range of motility, three times daily. Currently bachelor rehabilitation protocols limit agile contraction of the biceps brachii musculus until weeks eight‐10 (Figure 5).4 In order to strengthen other muscles, such every bit the scapular and glenohumeral stabilizers (rhomboids, latissimus dorsi, middle trapezius, etc), an exercise was developed in which the patient bilaterally actively retracted his scapulae and extended his shoulders at the gleno‐humeral joint against elastic resistance (Figure half-dozen). This exercise strengthens the scapular stabilizers without placing boosted stress on the biceps brachii muscle. Low biceps activity during operation of this practise was confirmed by transmission palpation. Recent testify has shown that biceps brachii electromyographic activity during scapular retraction has been measured to be less than x% of maximal voluntary wrinkle.18 The patient was likewise placed seated on an practice ball during the exercise in order to help increment abdominal and trunk muscle recruitment.
Double thera‐band scapular retraction and shoulder extension. Note that the biceps brachii contraction is insignificant in this position assuasive for strengthening of the scapular and gleno‐humeral stabilizers while all the same adhering to the specific physician protocol limiting active biceps strengthening until week eight of rehabilitation.
At the end of week two, ROM was reassessed and demonstrated improvement when compared to baseline (Table ii). In addition, the patient's recovery of ROM was considered alee of schedule, as the last measurement taken (5 degrees of flexion, or defective 5 degrees from full extension) surpassed what the physician protocol had suggested by the start of calendar week iii (twenty degrees of flexion) and calendar week four (10 degrees of flexion). At week four, range of motion was assessed a 3rd fourth dimension. At this fourth dimension, the patient had regained full passive extension without pain. Although the patient was still minimally limited in passive flexion, he was making a more rapid recovery than is typically observed.3,12,13
Table 2.
Patient active range of movement in extension. Annotation how the patients range of motion differed than that of the physician recommendations.
| Initial Exam | 2 Weeks | 4 Weeks | |
|---|---|---|---|
| Patient presentation | 35 deg of flexion | 5 deg of flexion | 0 |
| Dr. Recommendations | 10 | 30 deg of flexion | ten deg of flexion |
At post‐operative week 3 the patient began phase II of rehabilitation (weeks 3‐6), consisting of exercises that focused on strengthening supporting musculature including scapular stabilizers, shoulder rotator gage, and forearm. The intensity of exercises already in the handling protocol (Appendix one) was gradually increased to progress toward complete recovery. At no time during the rehabilitation process did the patient feel whatever adverse reactions or increment in pain with whatsoever of the ROM or strengthening exercises.
After full AROM was achieved by week 4, the authors adamant that the patient was set to initiate joint strengthening of the biceps muscle, nonetheless, physician orders prohibited this until the 8th week of rehabilitation (Figure five). Information technology was during weeks 8‐10 that exercises were added to strengthen the biceps brachii specifically using single articulation exercises such equally bicep curls or multi‐joint exercises such as the latissimus dorsi pull‐down. At the 8th week, the patient reported that he had full function with his extremity and had no deficits with any activities of daily living (ADL).
Outcomes and Give-and-take
Patients who sustain a distal biceps tendon rupture and who undergo surgical intervention for reattachment fully recover and return to both functional and athletic activities without limitations.three,xv,nineteen,20,21,22 In this case, the patient was able to fully recover AROM within 4 weeks and eventually return to strengthening exercises without limitations past the 8thursday calendar week of rehabilitation (Appendix 1). The rate at which the patient's ROM normalized was faster than more often than not expected, and led the authors to implement newly devised exercises that enabled the patient to advance strengthening of supporting musculature of the upper back and shoulder girdle while limiting any contraindicated exercise or activeness that involved the biceps. It could exist that the patient was able to progress towards total extension ROM at a faster rate than previous protocols because of his history of advanced levels of concrete action and a loftier degree of motivation both of which are well known predictors for successful rehabilitation.three,iv Degree of physical action level prior to injury has been shown to have a positive effect on rehabilitation potential and the level of post‐injury motion and strength potential should be considered when managing the treatment process.2 These, along with the patient's relatively young age may besides have contributed to achieving rehabilitation outcomes alee of schedule. Overall, this article is just a case report, and generalizations to other/all patients who accept undergone distal biceps repairs cannot be made.
The authors believe that the results of this instance report add to the electric current knowledge regarding concrete therapy treatment for a distal biceps tendon repair while at the same time provide insights for future protocol considerations in active individuals. Most current protocols do not abet ambitious stretching, AROM, or strengthening of a surgically repaired distal biceps tendon early in the rehabilitation process due to the fear of a re‐rupture. At this time the most information on aggressive early rehabilitation of the distal biceps repair has been provided by Cheung et al. They detail a progressive PROM protocol starting immediately and reaching total ROM by the sixth week.four The patient in this instance study, yet, started AROM during week ane and isotonic joint strengthening of the biceps at the beginning of week 8. The strengthening protocol described in the present report was consistent with the timeline of Cheung et al, but was more than advanced than the physician orders prescribed (which indicated only isometric strengthening through weeks 8‐ten before the advocacy to isotonic exercises).four Conversely, both of these protocols are more than aggressive than the highly conservative procedures detailed by Thompson in which the injured extremity was placed in a cast for six weeks, with no active stretching until the 12th week, and no strengthening until the xvith week mail‐surgery.3
One factor that would accept strengthened this case report would have been to document the return of forcefulness in the patient'due south biceps brachii during the strengthening stage of the rehabilitation protocol as compared to his uninjured extremity. It would likewise have been benign to be able to detail the verbal corporeality of HEP ROM exercises the patient actually performed, which most likely aided in his early recovery.
One concept that has non been investigated in the literature is the outcome of strengthening exercises of the biceps (isometric or isotonic) early in the rehabilitation process, every bit presently every bit the patient can achieve full active ROM. Presently all published protocols for this item surgery prohibit any strengthening until well into the 8th week or after. It is likely that these same protocols were not developed with the expectation that patients could recover full ROM past the end of the sixth week. In the opinion of the authors' if total AROM can be accomplished before the sixth week of rehabilitation, initiating a slow transition into light strengthening of the biceps brachii may be condom for the patient and worth investigating. Future studies should evaluate the initiation of strengthening exercises when full AROM has been achieved in more than patients.
Conclusion
The distal biceps brachii tendon rupture is a relatively rare injury and there is currently express show available on rehabilitation techniques and guidelines for proper progression. In this instance report, the rate at which the patient'south ROM progressed during rehabilitation was faster than generally expected, and led the authors to implement newly devised exercises that enabled the patient to accelerate strengthening of supporting musculature of the upper dorsum and shoulder girdle while limiting any contraindicated do or activity that involved the biceps. While the overall handling plan did non differ significantly from the requested physician protocol, it is the authors' opinion that full AROM may be achieved before the sixth week of rehabilitation, and therefore, initiating a boring transition into light strengthening of the biceps brachii may be safe for patients and worth investigating with future research with larger numbers of subjects.
APPENDIX i: INTERVENTION PROTOCOL USED WITH THE Field of study OF THE Example Report
| Week 1 | Week 2 | Week 3 | Week four | Week 5‐6 | Week 8‐10 | |
|---|---|---|---|---|---|---|
| Elbow | AROM Ext: 2x10 (0 lbs) | AROM Ext: 2x10 (0 lbs) | AROM Ext: 2x10 (0 lbs) | AROM Ext: 2x10 (0 lbs) | AROM Ext: 2x10 (0 lbs) | AROM Ext: 2x10 (0 lbs) |
| Joint mobilizations as needed | PROM stretching ext/flex: 5x30 sec | PROM stretching ext/flex: 5x30 sec | PROM stretching ext/flex: 5x30 sec | PROM stretching ext/flex: 5x30 sec | PROM stretching ext/flex: 5x30 sec | |
| Joint mobiliza¬tions as needed | BOSU ‐ Button Up | |||||
| Bicep Curl ‐ 2x10 (4 lbs) | ||||||
| Tricep Extension ‐ 2x10 (10 lbs) | ||||||
| Forearm | Ext/Flex: 3x10 each direction (0 lbs) | Ext/Flex: 3x10 each direction (1 lbs) | Ext/Flex: 3x10 each direction (two lbs) | Ext/Flex: 3x10 each direction (4 lbs) | Ext/Flex: 3x10 each direction (5 lbs) | Ext/Flex: 3x10 each direction (five lbs) |
| Hammer radial/ulnar deviation: 3x10 each direction (0 lbs) | Hammer radial/ulnar departure: 3x10 each direction (1 lbs) | Hammer radial/ulnar deviation: 3x10 each direction (2 lbs) | Hammer radial/ulnar deviation: 3x10 each direction (four lbs) | Hammer radial/ulnar divergence: 3x10 each management (five lbs) | Hammer radial/ulnar deviation: 3x10 each direction (5 lbs) | |
| Shoulder | AROM flexion: 3x10 (Cane) | AROM flexion: 3x10 (one lbs) | AROM flexion: 3x10 (1 lbs‐3 lbs) | AROM flexion: 3x10 (5 lbs) | AROM flexion: 3x10 (5 lbs) | AROM flexion: 3x10 (v lbs) |
| Shoulder stretching in all directions (Flex, Abd, ER, IR): 5x30 seconds | Shoulder stretching in all directions (Flex, Abd, ER, IR): 5x30 seconds | Shoulder stretching in all directions (Flex, Abd, ER, IR): 5x30 seconds | Shoulder stretching in all directions (Flex, Abd, ER, IR): 5x30 seconds | Shoulder stretching in all directions (Flex, Abd, ER, IR): 5x30 seconds | Shoulder stretching in all directions (Flex, Abd, ER, IR): 5x30 seconds | |
| T‐Band Ext: x30 reps (Green Ring) | T‐Ring Ext: x30 reps (Green Band) | T‐Band Ext: x30 reps (Light-green Ring) | ||||
| Shrugs: x30 reps (v lbs) | Shrugs: x30 reps (8 lbs) | Shrugs: x30 reps (8 lbs) | ||||
| Prone Horiz. Abd: x30 reps (ane lbs) | Decumbent I‐T‐Y: x30 reps each direction (i lbs) | |||||
| Prone Horiz. Abd: x30 reps (i lbs) | Decumbent I‐T‐Y: x30 reps each direction (1 lbs) | |||||
| Standing Row: 5 lb bar | ||||||
| Lat Pulldown Machine: 3x10 (40 lbs) | ||||||
| Scapular Stabilizers | Scapular retraction double T‐Band on ball: 3x10 (Bluish T‐Band resistance) | Scapular retrac¬tion double T‐Band on ball: 3x10 (Black T‐Band resistance) | Scapular retraction double T‐Band on brawl: 3x10 (Argent T‐Band resistance) | Scapular retraction double T‐Band on ball: 3x10 (Silver T‐Band resistance) | Scapular retraction double T‐Band on ball: 3x10 (Argent T‐Band resistance) | Scapular retraction double T‐Band on ball: 3x10 (Silver T‐Ring resistance) |
| Scapular retrac¬tion into do ball: 2x10 | Scapular retraction into exercise brawl: 2x10 | Scapular retraction into practice ball: 2x10 | Scapular retraction into exercise ball: 2x10 | Scapular retraction into exercise brawl: 2x10 | ||
| Serratus punches in supine: x30 reps (two lb weight) | Serratus punches in supine: x30 reps (4 lb weight) | Serratus punches in supine: x30 reps (5 lb weight) | Serratus punches in supine: x30 reps (five lb weight) | Serratus punches in supine: x30 reps (5 lb weight) |
REFERENCES
ane. Gilcreest EL. (1933). Rupture of musculus and tendons, particularly subcutaneous rupture of the biceps flexor cubiti. JAMA. 84:1819‐1822 [Google Scholar]
two. Lintner South, Fischer T. (1996). Repair of the distal biceps tendon using suture anchors and an anterior arroyo. Clinical Orthopedics and Related Inquiry. 322: 116‐119 [PubMed] [Google Scholar]
3. Thompson One thousand, (1998). Rupture of the distal biceps tendon in a collegiate football game player: A instance study. Journal of Able-bodied Training. 33:62‐64 [PMC free article] [PubMed] [Google Scholar]
iv. Athwal GS, Steinmann SP, Rispoli DM. (2007). The distal biceps tendon: footprint and relevant clinical anatomy. The Journal of Mitt Surgery. 32A(viii). [PubMed] [Google Scholar]
five. Morrey B.F, Askew LJ, An KN, Dobyns JH. (1985). Rupture of the distal biceps brachii tendon. A biomechanical written report. J Bone Joint Surg Am. 67: 418‐421 [PubMed] [Google Scholar]
vi. Rantanen J, Orava Southward. (1999). Rupture of the distal biceps tendon. A report of xix patients treated with anatomic reinsertion, and a meta‐analysis of 147 cases found in the literature. Am J Sports Med. 27:ii:128‐132 [PubMed] [Google Scholar]
7. Gilroy AM, MacPherson BR, Ross LM, (2008). Atlas of Anatomy. New York: Thieme Medical Publishers [Google Scholar]
eight. Morrey BF. (2000). Injury of the flexors of the elbow: biceps in tendon injury. The elbow and its disorders. 3rd ed. Philadelphia, Pa: Saunders, 468‐478 [Google Scholar]
9. John CK, Field LD, Weiss KS, Savoie FH. (2007). Single‐incision repair of aute distal biceps ruptures by use of suture anchors. Journal of Shoulder and Elbow Surgery. sixteen(1). [PubMed] [Google Scholar]
10. Hurov JR. (1996). Controlled active mobilization following surgical repair of the avulsed radial attachment of the biceps brachii muscle: A instance study. JOSPT. 23 (vi): 382‐387 [PubMed] [Google Scholar]
eleven. Kettler M, Lunger J, Kuhn Five, et al. (2007). Failure strengths in distal biceps tendon repair. Am J Sports Med. 35:1544‐1548 [PubMed] [Google Scholar]
12. Heinzelmann Advert, Savoie FH, Ramsey JR, et al. (2009). A combined technique for distal biceps repair using a soft tissue button and biotenodesis interference screw. Am J Sports Med 37:989. [PubMed] [Google Scholar]
13. Cheung EV, Lazarus K, Taranta One thousand. (2005). Immediate range of motility after the distal biceps tendon repair. J. Shoulder Elbow Surg. 14:516‐viii [PubMed] [Google Scholar]
15. Sethi PM, Tibone JE. (2008). Distal biceps repair using cortical push fixation. Sports Med Arthrosc Rev. one 6: 130‐135 [PubMed] [Google Scholar]
16. Li 50, Liu Ten, Herr G. (2007). Postoperative pain intensity assessment: a comparison of four scales in Chinese adults. Hurting Med. 8(3):223‐34 [PubMed] [Google Scholar]
17. Stratford Pow, Spadoni GF. (2001). The reliability, consistency, and clinical awarding of a numeric pain rating scale. Physiotherapy Canada, 51(ii), 88‐91 [Google Scholar]
18. Smith J, Dahm DL, Kaufman KR, et al. (2006). Electromyographic activity in the immobilized shoulder girdle musculature during scapulothoracic exercises. Arch Phys Med Rehabil, 87:923‐7 [PubMed] [Google Scholar]
xix. Baker BD, Bierwagen D. (1985). Rupture of the distal biceps brachii; operative versus nonoperative handling. J Bone Joint Sug Am. 67:414‐417 [PubMed] [Google Scholar]
xx. D'Alessandro DR, Shields CL, Tibone JE, et al. (1993). Repair of distal biceps tendon repair in athletes. American Journal of Sports Medicine. 21:ane: 114‐119 [PubMed] [Google Scholar]
21. Lois DS, Hankin FM, Eckenrode JF, et al. (1986). Distal biceps brachii tendon avulsion. A simplified method of operative repair. The American Journal of Sports Medicine. fourteen:3 [PubMed] [Google Scholar]
22. Rantanen J, Orava Southward. (1999). Rupture of the distal biceps tendon. A report of nineteen patients treated with anatomic reinsertion, and a meta‐analysis of 147 cases found in the literature. Am J Sports Med. 27:2:128‐132 [PubMed] [Google Scholar]
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3537453/
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