JSES - 2026-06-11 - Journal Article
Is there still room for conservative treatment of Distal Biceps Tendon ruptures? What patients (and surgeons) should know. A case series with a mean 4-years follow-up.
Coliva F, Marinelli A, Riva M, Valentina V, Tortorella F, Minerba M, Cavallo M, Guerra E
Topics
Key Takeaway
Conservative management of distal biceps tendon ruptures yields mean supination strength deficits of only 11% and DASH scores of 10.1 at mean 47.8 months, but heavy/repetitive manual workers had significantly worse functional outcomes (p=0.01 DASH, p=0.009 MEPS) and higher pain rates (p=0.0125).
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Summary
This retrospective case series evaluated mid-term outcomes of nonoperative distal biceps tendon rupture management in 30 patients (97% male, mean age 48.9 years) using dynamometry, DASH, and MEPS at mean 47.8 months. Mean supination and flexion strength deficits were 11% and 4–5%, respectively; mean DASH was 10.1 and MEPS 97.5. Heavy/repetitive manual work was independently associated with worse DASH (p=0.01), worse MEPS (p=0.009), and higher pain incidence (p=0.0125), while arm dominance had no significant effect.
Key Limitation
The heterogeneous, self-selected nonoperative cohort (surgery refusal vs. low demand vs. chronic presentation) conflates fundamentally different patient profiles, making it impossible to isolate the true effect of conservative treatment from patient-driven selection.
Original Abstract
AIM/BACKGROUND
Distal biceps tendon (DBT) ruptures are uncommon injuries that typically require surgical repair in patients with high functional demands. Non-operative treatment is usually reserved for sedentary patients. Only a small number of studies with limited samples have investigated the outcomes of conservative treatment after DBT ruptures, and none have specifically assessed fatigue and pain. The aim of this study was to further characterize the mid-ter outcomes of conservative treatment and quantify fatigue and pain at mid-term follow-up.
METHODS
We retrospectively reviewed patients treated at our institution between 2006 and 2023 for DBT rupture who did not undergo surgical repair for any reason (e.g. surgery refusal, low functional demands, chronic presentation) and had a minimum follow-up of 1 year. Clinical outcomes were assessed using DASH and MEPS scores. Flexion and supination strength, as well as fatigue, were evaluated using dynamometry, comparing the affected to the contralateral side. We also analyzed the influence of occupational activity and arm dominance on clinical outcomes.
RESULTS
Thirty patients met the inclusion criteria and underwent clinical evaluation and dynamometry at a mean follow-up of 47.8 months. Ninety-seven percent were male, with a mean age of 48.9 years; the dominant limb was involved in 50% of cases. The mean deficits in peak and mean strength were 11% and 11% for supination, and 4% and 5% for flexion, respectively. Nine patients (22.5%) reported significant pain during repetitive activities. Mean DASH and MEPS scores at final follow-up were 10.1 and 97.5, respectively. Heavy or repetitive manual work was significantly associated with poorer DASH (p=0.01) and MEPS (p=0.009) scores and with a higher incidence of pain (p=0.0125). Arm dominance was not significantly associated with outcomes or pain.
CONCLUSIONS
Based on these data, conservative treatment for DBT ruptures remains a viable option in sedentary patients, resulting in limited strength deficits that are usually not clinically relevant. Conservative treatment might lead to poorer clinical results in heavy and repetitive workers if compared to the sedentary group and therefore, in this population surgical management should be preferred and discussed. Conversely, this study highlights chronic pain as a potentially underappreciated issue that may significantly impact daily activities. Occupational demands should be carefully considered when selecting treatment, whereas limb dominance appears less relevant for clinical outcomes.