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Distal Biceps Repair
Patients with an acute distal biceps tendon rupture usually describe a specific event of a sudden extension force on a flexed elbow and may report hearing a “pop” at the time of rupture. Initially, the pain is sharp and tearing in the anterior forearm; it evolves into an aching pain persisting for weeks to months. Many have ecchymosis in the antecubital fossa and swelling and tenderness. Morrey described three criteria for diagnosis: (1) a history of a single traumatic event, (2) grossly palpable and visible signs of proximal retraction of the distal end of the biceps, and (3) weakness of flexion of the elbow and supination of the forearm. The O’Driscoll hook test may be used to identify an absence of the distal insertion: The patient’s arm is flexed to 90°, and the patient supinates the arm. If the distal tendon is intact, the examiner can hook a finger underneath. If absent, there is no structure to hook.