Outcomes and practical information for patients choosing nonoperative treatment for distal biceps ruptures

The goal of this study was to evaluate the outcomes of patients selecting nonoperative treatment for distal biceps tendon ruptures to provide information to patients and caregivers to consider in decision making. Five men conservatively treated for distal biceps tendon rupture between November 2002 and December 2006 were compared to 5 age-matched controls treated operatively. Outcomes at 4.5 years included supination strength, range of motion, and American Shoulder and Elbow Surgeons (ASES) score. Two groups of 9 normal volunteers--1 young group averaging 30.7 years and 1 older group averaging 48.8 years--served as controls. In nonoperative patients, elbow supination strength in the injured arm was 4.14 Nm (SD 0.94) and in the uninjured arm was 4.91 Nm (SD 0.65). In operative patients, supination strength was 4.25+/-1.08 Nm in the operatively repaired arm and 5.74+/-1.27 Nm in the uninjured arm. Age-matched normal patients had supination strength of 5.78+/-1.46 Nm in the dominant arm and 5.59+/-1.32 Nm in the nondominant arm. The ASES score averaged 89.57, with 3 patients reporting pain, compared to a score of 87.5 in the operative patients. Patients choosing conservative treatment for distal biceps ruptures have residual pain and weakness approximately double that seen between normal dominant and non-dominant extremities.