Is orthopedic surgery effective for treating forearm muscle tendon ruptures?

Orthopedic Surgery for Forearm Muscle Tendon Rupture

Surgery is an effective treatment option for forearm muscle tendon ruptures when conservative management fails, with surgical repair being the most reliable method to restore flexion and supination strength in the elbow and forearm after acute rupture. 1, 2

Diagnostic Approach

Before surgical intervention, proper diagnosis is essential:

• MRI is the most accurate imaging modality for identifying the type of tendon tear, enabling orthopedic surgeons to provide a more precise treatment plan 1
• Ultrasound can be considered as an alternative to MRI but has limitations in detecting partial tears 1

Surgical Management

Surgical approaches for forearm tendon ruptures vary based on the specific tendon involved:

Distal Biceps Tendon Repair

Two main surgical approaches exist:

1. Single anterior incision technique

   • Advantages: Minimal risk of heterotopic bone formation
   • Disadvantages: Greater risk of posterior interosseous nerve injury

2. Two-incision technique (anterior and lateral)

   • Advantages: Reduced risk of radial nerve palsy
   • Disadvantages: Higher likelihood of heterotopic bone formation limiting forearm rotation 2

Endoscopic Repair

• Newer endoscopic techniques using suture anchors have shown promising results
• Can be performed through a small 3-cm incision in the anterior crease of the forearm
• Provides good functional outcomes with early recovery and fewer complications 3

Post-Surgical Rehabilitation

Rehabilitation is crucial for optimal recovery:

• Median immobilization periods after surgical repair:

  • Primary repair: 6.0 weeks (range 0-12)
  • Tenodesis: 7.0 weeks (range 3.0-13)
  • Grafting: 6.3 weeks (range 3.0-13)
  • End-to-end suturing: 8.0 weeks (range 6.0-11) 4

• Early range of motion:

  • 41% of studies report initiating range of motion exercises within 4 weeks after surgery
  • There's a trend toward shorter immobilization time and early range of motion 4

• Protected weight-bearing with devices that allow mobilization by 2-4 weeks postoperatively is recommended 1

Outcomes and Return to Activities

• Most patients regain near-normal upper extremity motion and function
• Patients can typically return to preinjury activities
• Small measurable deficits in power, endurance, and terminal forearm rotation may persist 2
• Return to sports activities can be expected within 3-6 months after surgical treatment 1

Potential Complications

• Rerupture after repair is uncommon with either surgical technique
• Risk of complications increases with delay in surgical intervention after rupture
• Potential complications include:
  • Heterotopic bone formation
  • Nerve injuries (radial or median nerve)
  • Ectopic ossifications 2, 3

Important Considerations

• Surgery is most effective when performed early after injury
• The specific surgical approach should be selected based on the location and extent of the tendon rupture
• Appropriate directed rehabilitation is an essential factor in the clinical success of surgically treated tendon ruptures 4

Surgical repair remains the gold standard for treatment of complete forearm tendon ruptures, particularly for patients who require restoration of full strength and function for occupational or athletic activities.