Is there still room for conservative treatment of Distal Biceps Tendon ruptures? What patients (and surgeons) should know. A case series with a mean 4-years follow-up.

AIM/BACKGROUND: Distal biceps tendon (DBT) ruptures are uncommon injuries that typically require surgical repair in patients with high functional demands. Non-operative treatment is usually reserved for sedentary patients. Only a small number of studies with limited samples have investigated the outcomes of conservative treatment after DBT ruptures, and none have specifically assessed fatigue and pain. The aim of this study was to further characterize the mid-ter outcomes of conservative treatment and quantify fatigue and pain at mid-term follow-up.

METHODS: We retrospectively reviewed patients treated at our institution between 2006 and 2023 for DBT rupture who did not undergo surgical repair for any reason (e.g. surgery refusal, low functional demands, chronic presentation) and had a minimum follow-up of 1 year. Clinical outcomes were assessed using DASH and MEPS scores. Flexion and supination strength, as well as fatigue, were evaluated using dynamometry, comparing the affected to the contralateral side. We also analyzed the influence of occupational activity and arm dominance on clinical outcomes.

RESULTS: Thirty patients met the inclusion criteria and underwent clinical evaluation and dynamometry at a mean follow-up of 47.8 months. Ninety-seven percent were male, with a mean age of 48.9 years; the dominant limb was involved in 50% of cases. The mean deficits in peak and mean strength were 11% and 11% for supination, and 4% and 5% for flexion, respectively. Nine patients (22.5%) reported significant pain during repetitive activities. Mean DASH and MEPS scores at final follow-up were 10.1 and 97.5, respectively. Heavy or repetitive manual work was significantly associated with poorer DASH (p=0.01) and MEPS (p=0.009) scores and with a higher incidence of pain (p=0.0125). Arm dominance was not significantly associated with outcomes or pain.

CONCLUSIONS: Based on these data, conservative treatment for DBT ruptures remains a viable option in sedentary patients, resulting in limited strength deficits that are usually not clinically relevant. Conservative treatment might lead to poorer clinical results in heavy and repetitive workers if compared to the sedentary group and therefore, in this population surgical management should be preferred and discussed. Conversely, this study highlights chronic pain as a potentially underappreciated issue that may significantly impact daily activities. Occupational demands should be carefully considered when selecting treatment, whereas limb dominance appears less relevant for clinical outcomes.