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Risk Factors for Failing Non-Operative Treatment of a Partial Distal Biceps Tear
Samuel Cohen-Tanugi, MD
1; Gretchen Maughan, MSPH
2; Mario Quesada, BS
1; John Curran, BS
1; Hernan Roca, MD
1; Brittany N. Garcia, MD
31University of Utah, SLC, UT; 2University of Utah, Salt Lake City, UT; 3University of Utah Hospital, Salt Lake City, UT
Introduction: The management of partial tears of the distal biceps tendon remains a controversial topic with a very limited evidence base to guide surgeons and patients
1. We hypothesized that among patients with partial tears of the distal biceps tendon, certain baseline characteristics such as tear size would constitute risk factors for failing non-operative management.
Methods: This was a retrospective review of patients diagnosed with a partial tear of the distal biceps tendon at a single, academic medical center. Patients were identified through a database of MRIs obtained at our institution according to ICD-10 codes. Medical records were reviewed to confirm the patients' diagnosis, collect demographic factors, injury characteristics, and information regarding treatment. Patients were stratified into two groups: successful non-operative management, or surgery after failure of non-operative management. Statistical analyses were performed using Wilcoxon rank sum and Fishers Exact tests.
Results: We identified 85 patients with partial tears of the distal biceps tendon of which 58 attempted non-operative treatment. The mean age of these 58 patients was 56 and 86% were male. 76% reported a traumatic onset to their symptoms and 41% of patients failed non-operative treatment and received surgical intervention at our institution. We evaluated the correlation between failing non-operative treatment and injury and demographic variables including age, sex laboring occupation, initial pain, tear size, injury to dominate arm and traumatic onset. Of these evaluated factors only tear size of >50% was found to be correlated with failure of non-operative treatment (p=0.01).
Conclusions: At a single large academic institution, a majority of patients who failed non-operative treatment for distal biceps tears were diagnosed with a high-grade tear based on MRI imaging. Other baseline characteristics were not associated with failing non-operative treatment. These findings may help guide surgeons in deciding when to offer early surgical intervention to patients with partial tears and when non-operative management is more likely to be successful. This study reports comparable findings to the only other investigation of the success of non-operative management of this injury
1.
- Bauer TM, Wong JC, Lazarus MD. Is nonoperative management of partial distal biceps tears really successful? J Shoulder Elbow Surg. 2018 Apr;27(4):720-725. doi: 10.1016/j.jse.2017.12.010. Epub 2018 Feb 1. PMID: 29396100.
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