Distal biceps tendon ruptures occur with the almost extended elbow and supinated forearm – an online video analytic study

• Authors: Sebastian Lappen, Technical University of Munich; Sebastian Siebenlist, Technical University of Munich; Pavel Kadantsev, Technical University of Munich; Maximilian Hinz, Technical University of Munich; Jesse Seilern und Aspang, Emory University; Patricia M Lutz, Technical University of Munich; Andreas B Imhoff, Technical University of Munich; Stephanie Geyer, Technical University of Munich
• Journal Title: BMC MUSCULOSKELETAL DISORDERS
• Volume: Volume 23
• Publisher: BioMed Central | 2022-06-22
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1186/s12891-022-05546-9
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Distal biceps; Tendon rupture; Sport injuries; Weightlifting; Injury mechanism

Abstract

Background Distal biceps tendon ruptures can lead to significant restrictions in affected patients. The mechanisms of injury described in scientific literature are based exclusively on case reports and theoretical models. This study aimed to determine the position of the upper extremities and forces involved in tendon rupture through analyzing video recordings. Methods The public YouTube.com database was queried for videos capturing a clear view of a distal biceps tendon rupture. Two orthopedic surgeons independently assessed the videos for the activity that led to the rupture, the arm position at the time of injury and the forces imposed on the elbow joint. Results Fifty-six video segments of a distal biceps rupture were included (55 male). In 96.4%, the distal biceps tendon ruptured with the forearm supinated and the elbow isometrically extended (non-dynamic muscle engagement) (71.4%) or slightly flexed (24%). The most common shoulder positions were adduction (85.7%) and neutral position with respect to rotation (92.9%). Most frequently a tensile force was enacted on the elbow (92.9%) and the most common activity observed was deadlifting (71.4%). Conclusion Distal biceps tendon ruptures were most commonly observed in weightlifting with a slightly flexed or isometrically extended elbow and forearm supination. These observations may provide useful information for sports specific evidence-based injury prevention, particularly in high performing athletes and individuals engaged in resistance training.