Biceps tendon pathology

Distal biceps tendon pathology includes a spectrum of conditions, from insertional tendinopathy to partial and complete tears of the tendon. While complete tears tend to be traumatic and occur with eccentric elbow flexion, partial tears can be related to an underlying systemic disease or anabolic steroid abuse, cause deep-seated anterior elbow pain and require a high index of suspicion for diagnosis. The signs of partial tears are often subtle and diagnosis may be difficult owing to unreliable clinical examination and imaging. Endoscopy may be used for diagnosis and provides detailed understanding of the pathoanatomy of the distal tendon where other modalities have failed. Tears may lead to significant deficits in supination strength and endurance when compared to the contralateral arm and often require repair. A number of operative techniques, including two-incision, single anterior incision and endoscopic distal biceps repair, have been used for those ruptures requiring repair. The aim of this chapter is to describe biceps pathology and the operative techniques used in tendon repair.