Advancement of the insertion of the biceps brachii muscle: a technique for increasing elbow flexion force

A new technique for increasing weak flexion force of the elbow in patients with brachial plexus injuries is reported. The concept of this procedure is to increase the moment arm of the biceps brachii muscle by moving the point of action distally. Advancement of the insertion of the biceps brachii muscle was performed with an anterior approach to the radius. The biceps tendon was stripped off the radius at its insertion. A hole was dug into the radius 2 cm distal to the original insertion. The biceps tendon was then reattached to the drill holes made in the distal edge of the initial hole with the elbow in 30 degrees of flexion. After immobilization in 70 degrees of flexion for 5 weeks, range-of-motion exercises were initiated. This procedure was applied in six cases of brachial plexus injury. Flexion force at the elbow was increased, and the initial motion of elbow flexion has become very smooth in all patients. Consequently the activities of daily living are easier to perform. This procedure is simple and involves no functional or tissue sacrifice.