24/02/13

1

Lésions  du  biceps  et  du  triceps

Geoffroy Nourissat MD PhD Clinique des Maussins Hôpital Saint Antoine

UR4 Stress-vieillissement-inflammation, UPMC Paris, France

DIU Pathologie du Sport , Bichat le 22 fevrier 2013

Anatomie

Articulation du coudeArticulation du coudeVue médialeVue médiale

1- Membrane interosseuse1- Membrane interosseuse

2- tendon du biceps brachial2- tendon du biceps brachial

3- Ligament annulaire3- Ligament annulaire

4 Capsule articulaire4 Capsule articulaire

5- Corde oblique5- Corde oblique

6 Tendon du brachial 6 Tendon du brachial antérieurantérieur

7- L.L.I Fx Moyen7- L.L.I Fx Moyen

8- L.L.I. Fx antérieur8- L.L.I. Fx antérieur

9- L.L.I. Fx arciforme9- L.L.I. Fx arciforme

10 10 –– L.L.I Fx. Postérieur L.L.I Fx. Postérieur

11- tendon du triceps brachial11- tendon du triceps brachial

Bourses synoviales du coudeBourses synoviales du coude

1- Brachial antérieur1- Brachial antérieur

2- Biceps brachial2- Biceps brachial

3- Bourse séreuse 3- Bourse séreuse bicipito-bicipito-radialeradiale

4- Triceps brachial4- Triceps brachial

5- Bourse sous tendineuse5- Bourse sous tendineusedu tricepsdu triceps

6- Bourse 6- Bourse intraintra tendineuse de tendineuse dell’’olécraneolécrane

7- Bourse sous cutanée7- Bourse sous cutanéeolécranienneolécranienne

Anatomie Anatomie

and classified the morphology of the bicipital tu-berosity ridge as smooth (absent), small, medium,large, or bifid.

The purpose of our study was to map the footprintof the biceps tendon insertion on the bicipital tuber-osity of the radius and to report on the local relevantanatomy to assist surgeons with correct tendon ori-entation for anatomic repair.

Materials and MethodsFifteen fresh frozen adult upper extremities wereused in this study. The specimens had no signs ofprior trauma or surgery and individuals were a meanage of 78 years at the time of death (range, 57–91 y).Specimens were from 7 men and 8 women. Thisstudy was approved by our institutional researchcommittee.

The specimens were stripped of all skin and sub-cutaneous tissue to identify the long head of thebiceps, the short head of the biceps, the lacertusfibrosus, and the distal biceps tendon. The long andshort heads of the biceps muscle were then detachedfrom their origins along with the lacertus fibrosusfrom its insertion. The proximal radius was thenremoved en bloc with the biceps muscle. Dissectionwas performed, using 2.5! loupe magnification,from the proximal tendons (long and short) towardthe muscle bellies to separate the short head of thebiceps muscle belly from the long head of the bicepsmuscle belly. The relationships between the longhead of the biceps tendon, the short head of thebiceps tendon, the muscle bellies, and the distal ten-don orientation were examined.

The length and width of the biceps tendon inser-tion and the distance between the articular margin ofthe radial head and the start of the biceps tendoninsertion was measured with calipers (General Tools,New York, NY). The tendon footprint area was mea-sured by sharply incising the tendon and marking theinsertion with a permanent ultrafine-tipped marker.The marked area was measured by laying an acetategrid sheet over the bicipital tuberosity and countingthe number of 1 ! 1 mm squares occupied by themarked area. The measurements were repeated 3times by the same investigator.

ResultsGross AnatomyIn all specimens examined, the biceps musculotendi-nous unit rotated 90° externally from origin to inser-tion (Fig. 1). In 2 specimens, the long head of thebiceps and the short head of the biceps remained as

independent muscle bellies and as independent distaltendons to their uniquely separate insertions on thebicipital tuberosity. In these 2 specimens, the longhead of the distal tendon was inserted onto the prox-imal aspect of the tuberosity while the short head ofthe distal tendon was inserted onto the distal aspectof the tuberosity. In 8 specimens, the long head andshort heads of the muscle bellies and their corre-sponding distal tendons could be easily separated andfollowed to their unique insertion areas on the bicip-ital tuberosity. As in the 2 specimens with com-pletely separate muscle bellies, the long head of thedistal tendon in these 8 specimens was inserted prox-imally on the tuberosity, and the short head of thedistal tendon was inserted distally on the tuberosity(Fig. 2). In 5 specimens, the short and long heads ofthe muscle bellies coalesced distally, and their cor-responding distal tendons were connected together.In these specimens, the muscle bellies could be sep-arated with a minimal amount of dissection. Theirdistal tendons were more adherent to each other andcould be grossly divided; however, their fibers coa-

Figure 1. The biceps musculotendinous unit is illustratedfrom origin to insertion. The lacertus fibrosus is found tooriginate from the proximal aspect of the short head of thedistal tendon. The short head of the distal tendon was in-serted at the distal ulnar aspect on the bicipital tuberositywhile the long head of the distal tendon was inserted at theproximal ulnar aspect.

1226 The Journal of Hand Surgery / Vol. 32A No. 8 October 2007

lesced enough that precise calculation of the individ-ual footprints was difficult and therefore thought tobe imprecise and was abandoned.

The lacertus fibrosus was examined and found tooriginate from the proximal aspect of the short headof the distal tendon (Fig. 1) in all 15 specimens.

Tendon InsertionIn all specimens, the biceps tendon insertion waslocated along the extreme ulnar margin of the bicip-ital tuberosity (Fig. 3). The tendon is ribbon-shapedjust proximal to its insertion; however, as it ap-proaches the tuberosity the tendon thickens in widthand length creating a true “footprint” on the tuber-osity. The average distance from the articular marginof the radial head to the start of the biceps tendoninsertion in all specimens was 23 mm (range, 18–27mm); the average distance in the male specimens was25 mm (range, 22 to 27 mm) and in the female speci-mens was 22 mm (range, 18–25 mm). The averagelength of the biceps tendon insertion on the tuberositywas 21 mm (range, 17–25 mm) and the average widthwas 7 mm (range, 6–10 mm). The average length and

width of the biceps insertion in the male specimenswere 22 mm and 8 mm, respectively, and in thefemale specimens were 20 mm and 7 mm, respec-tively. The average area of the biceps tendon inser-tion�(footprint)�in�all�specimens�was�108�mm2�(range,81–135� mm2).� The� average� area� in� the� male� andfemale� specimens� was� 112� mm2� and� 104� mm2, re-spectively.

In 10 specimens the exact dimensions and area ofthe short- and long-head tendon insertions could becalculated. The short-head tendon insertion on thebicipital tuberosity averaged 12 mm in length, 7 mmin�width�and�60�mm2� in�area.�The�long-head�tendoninsertion on the bicipital tuberosity averaged 9 mm inlength,�7�mm�in�width�and�48�mm2� in�area.

DiscussionThe purpose of this anatomic project was to providequantitative data on the dimensions and area of thebiceps tendon insertion on the radius and to identifylocal landmarks to assist with correct tendon orien-tation. The clinical importance of re-creating normaldistal biceps tendon orientation is unknown; how-

Figure 2. The long- and short-head biceps tendon insertions are illustrated (A). The mean footprint area of the long head of thetendon was 48 mm2 and of the short head of the tendon was 60 mm2. A cadaveric specimen (B) demonstrates the separationbetween the short and long heads of the distal tendons (white arrow) with near complete rupture of the short head of the distaltendon (black arrow).

Athwal, Steinmann, and Rispoli / Distal Biceps Tendon Anatomy 1227

lesced enough that precise calculation of the individ-ual footprints was difficult and therefore thought tobe imprecise and was abandoned.

The lacertus fibrosus was examined and found tooriginate from the proximal aspect of the short headof the distal tendon (Fig. 1) in all 15 specimens.

Tendon InsertionIn all specimens, the biceps tendon insertion waslocated along the extreme ulnar margin of the bicip-ital tuberosity (Fig. 3). The tendon is ribbon-shapedjust proximal to its insertion; however, as it ap-proaches the tuberosity the tendon thickens in widthand length creating a true “footprint” on the tuber-osity. The average distance from the articular marginof the radial head to the start of the biceps tendoninsertion in all specimens was 23 mm (range, 18–27mm); the average distance in the male specimens was25 mm (range, 22 to 27 mm) and in the female speci-mens was 22 mm (range, 18–25 mm). The averagelength of the biceps tendon insertion on the tuberositywas 21 mm (range, 17–25 mm) and the average widthwas 7 mm (range, 6–10 mm). The average length and

width of the biceps insertion in the male specimenswere 22 mm and 8 mm, respectively, and in thefemale specimens were 20 mm and 7 mm, respec-tively. The average area of the biceps tendon inser-tion�(footprint)�in�all�specimens�was�108�mm2�(range,81–135� mm2).� The� average� area� in� the� male� andfemale� specimens� was� 112� mm2� and� 104� mm2, re-spectively.

In 10 specimens the exact dimensions and area ofthe short- and long-head tendon insertions could becalculated. The short-head tendon insertion on thebicipital tuberosity averaged 12 mm in length, 7 mmin�width�and�60�mm2� in�area.�The�long-head�tendoninsertion on the bicipital tuberosity averaged 9 mm inlength,�7�mm�in�width�and�48�mm2� in�area.

DiscussionThe purpose of this anatomic project was to providequantitative data on the dimensions and area of thebiceps tendon insertion on the radius and to identifylocal landmarks to assist with correct tendon orien-tation. The clinical importance of re-creating normaldistal biceps tendon orientation is unknown; how-

Figure 2. The long- and short-head biceps tendon insertions are illustrated (A). The mean footprint area of the long head of thetendon was 48 mm2 and of the short head of the tendon was 60 mm2. A cadaveric specimen (B) demonstrates the separationbetween the short and long heads of the distal tendons (white arrow) with near complete rupture of the short head of the distaltendon (black arrow).

Athwal, Steinmann, and Rispoli / Distal Biceps Tendon Anatomy 1227

Athwal JHS 2007

24 mm

21 mm

7 mm

Anatomie

Keener JSES 2010

aspect of the tendon was angled, whereas the medial aspectof tendon was straight (Figure 1). The mean length of thesuperficial triceps tendon was 15.2 cm (range, 13.3-17.1cm) measured from the tip of the olecranon to the mostproximal extent of the tendon medially. The distal aspect ofthe extensor tendon was more expansive laterally, wherefibers of the triceps fascia blended with the brachioradialisand common wrist extensors (Figure 2). The lateral tricepsexpansion was continuous with the superficial fascia of theanconeus muscle and antebrachial fascia inserting into theradial aspect of the proximal ulna distally (Figure 3, A).The medial triceps tendon inserted directly into the medialaspect of the olecranon process without an expansion(Figure 3, B). This fascia was continuous with the floor ofthe cubital tunnel in the majority of specimens. In allspecimens, a thin strip of triceps muscle was evidentadjacent to the most medial portion of the triceps tendoninsertion and the more central aspect of the tendon(Figure 2).

The most lateral aspect of the triceps tendon proper wasdivided sharply from the lateral triceps expansion(Figure 4). This demarcation was judged from the deepaspect of the tendon, where direct fiber insertion into theolecranon was most evident. The mean width of the tricepstendon proper at the tip of the olecranon was 23.7 mm(range, 22.6-24.8 mm) (Table II). The mean width of thelateral triceps expansion was 16.8 mm (range, 15.1-18.5mm). The mean maximum width of the olecranon at thelevel of the greater sigmoid notch was 26.9 mm (range,25.6-28.2 mm). The ratio of the mean triceps tendon properwidth to the mean width of the olecranon was 0.88. Thewidth of the medial and lateral triceps expansion wascalculated after a midline split of the central triceps tendonat the center of the olecranon. In this scenario, the meanmedial split tendon width was 12.1 mm (range, 11.5-12.7mm) and the lateral split tendon width was 28.4 mm (range,26.4-30.4 mm).

Deep anatomy

In all specimens, the deep aspect of the triceps tendonproper was covered by a thin layer of muscle directlyinserting into the olecranon (Figure 5). The measuredthickness of the central tendon insertion after removal ofthe deep muscle fibers at the level of the olecranon was 6.8mm (range, 6.4-7.1 mm) (Table I). The mean thickness ofthe triceps tendon and muscle layer combined was 9.5 mm(range, 8.9-10.1 mm) and 12.0 mm (range, 11.2-12.8 mm)at 3 and 6 cm, respectively, proximal to the triceps inser-tion. Both the triceps tendon width (r ! 0.744, P < .001)and thickness (r ! 0.467, P ! .004) as measured at theolecranon tip correlated with the width of the olecranon.

Muscle fibers were dissected from the deep tendon. Inall specimens, a broad and flat triceps tendon was appre-ciated. The medial aspect of the tendon was thicker than thelateral aspect. Further exposure consistently showeda distinct thickened, rolled tendon edge medially, withsignificant variability in size between specimens (Figure 6).Careful dissection showed that this medial tendon

Figure 2 Superficial tendon insertion anatomy: Posterior viewof a left elbow showing typical appearance of expansive lateraltriceps in continuity with anconeus fascia.

Figure 3 Superficial tendon insertion anatomy showing lateralaspect (A) and medial aspect of left elbow (B). There is a thin stripof muscle (asterisk) seen superficially between the central tricepstendon and the most medial aspect of the tendon.

Anatomy of the triceps brachii tendon 401

thickening was continuous with the remainder of the deeptendon in all specimens and was not separated by a distinctseptum or space. This medial tendon had muscle fibersinserting from both the medial and long head of the triceps.In all specimens, the deep medial thickening flattened at theinsertion and blended with the central tendon into theolecranon (Figure 7). In no specimens did the medial aspectof the tendon grossly have a separate or distinct insertioninto the olecranon process.

Insertional dimensions

The dimensions of the central tendon insertion into theolecranon process were measured after sharp dissection ofthe tendon from the bone. In all specimens, the distal aspectof the insertion was flat whereas the proximal aspect wasdome shaped (Figure 8). The mean medial-to-lateral width ofthe tendon insertional footprint was 20.9 mm (range, 19.7-22.1 mm) (Table I). The mean proximal-to-distal maximum

length of the tendon footprint was 13.4 mm (range, 12.8-14.2mm). The mean length from the tip of the olecranon processto the most proximal aspect of the tendon insertion near thecurved apex of the olecranon was 14.8 mm (range, 14.0-15.6mm). The width of the tendon attachment showed a moderatecorrelation with the olecranon width (r ! 0.585, P < .001),whereas the length showed a slight correlation (r! 0.363, P! .03). There was no significant correlation between theolecranon tipetoetendon distance and the width of theolecranon (r ! 0.299, P ! .08).

Discussion

The anatomy of the distal triceps tendon insertion hasreceived little attention in the orthopaedic literature. Anaccurate understanding of this anatomy is important for

Figure 4 Lateral triceps expansion. (A) Lateral aspect of leftelbow with surgical instrument showing superficial border oflateral triceps expansion and triceps tendon. (B) After inspectionof the deep aspect of the tendon and identification of its mostlateral insertion onto the olecranon, the lateral triceps expansion issplit from the triceps tendon proper.

Table II Triceps tendon anatomic measures (n ! 36)

Variable Mean(mm)

95%Confidenceinterval

Tendon length 152 146-158Tendon width 23.7 22.6-24.8Tendon thickness at 0 cm 6.8 6.4-7.1Tendon/muscle thickness at 3 cm 9.5 8.9-10.1Tendon/muscle thickness at 6 cm 12.0 11.2-12.8Olecranon width 26.9 25.6-28.2Lateral triceps expansion width 16.8 15.1-18.5Medial split tendon width 12.1 11.5-12.7Lateral split tendon width 28.4 26.4-30.4Medial-lateral footprint 20.9 19.7-22.1Proximal-distal footprint 13.4 12.8-14.2Olecranon tipetoetendon

distance14.8 14.0-15.6

Figure 5 Deep aspect of triceps tendon: Posterior view of leftelbow. The posterior elbow capsule and fat pad have beenremoved. The deep tendinous triceps insertion is covered withmuscle both medially and laterally.

402 J.D. Keener et al.

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3

100 specimens, the consistent presence of a well-developedlateral triceps expansion was noted; however, the fulldimensions of this tissue, including width, were notprovided. The lateral triceps expansion helps to strengthenthe entire triceps mechanism and should be considered intriceps-splitting approaches to the elbow. In our study,a midline split and reflection of the central tendon resultedin a mean medial tendon width of 12.1 mm and a muchlarger lateral tendon/expansion width of 28.4 mm. On thebasis of these findings, it may be advantageous inapproaches involving triceps splitting with reflection tosplit the central tendon 3 to 5 mm lateral to the midline.This would provide a larger medial tendon flap for securetriceps repair while not compromising the wider, reinforcedlateral triceps tendon.

Little attention has been given to the quantitative anatomyof the triceps tendon insertion into the olecranon.18 We foundthe mean tendon width at its insertion to be 20.9 mm, or 78%of the maximal width of the olecranon. The mean proximal-to-distal length of the triceps tendon insertion on the olec-ranon was 13.4 mm. Both dimensions correlated with the sizeof the olecranon. In addition, the tendon insertion narrows inwidth but expands in proximal-to-distal length comparedwith the tendon dimensions measured at the olecranon tip.The tendon footprint is dome shaped in appearance, with thewidest dimension located distally and longest dimensionlocated centrally. The insertional anatomy is clinically rele-vant for surgical repair of the triceps tendon. Current repairtechniques use either bone tunnels or suture anchors fortendon reattachment and may not adequately re-create thenative tendon footprint. Repair techniques should attempt tore-create the full width and depth of the tendon insertion,which appear to correlate with the width of the olecranon.Further studies are warranted to examine surgical techniquesthat better re-create the normal anatomic footprint to maxi-mize the potential for healing.

The mean proximal-to-distal length of the olecranon tipbefore tendon insertion in this study was 14.8 mm. Thedeep triceps insertion is covered by a thin capsular layerand fat pad protecting the deep tendon. The findings of thisstudy show that, at a minimum, 1 cm of bone from thenative olecranon tip can safely be removed before disrup-tion of the triceps insertion. Removal of osteophytes fromthe olecranon tip is often performed for debridement of theposterior compartment in osteoarthritic elbows. Bonyresection can be extended safely into the native olecranon,if needed, without disturbing the triceps insertion.Furthermore, findings from this study show a thin layer ofmuscle covering the deep aspect of the triceps tendon.Arthroscopic debridement of the posterior compartment ofthe elbow can safely extend posteriorly until the deepmuscular fibers of the triceps are seen without compro-mising the central tendon.

Limitations of this study should be considered. Themean specimen age was 71.3 years, which corresponds tothe typical total elbow replacement cohort age but is mucholder than the age of most patients with triceps tendonruptures. Despite this limitation, we believe the anatomicfindings are relevant. Histologic analysis of the tricepsinsertion was not performed to confirm the presence ofa confluent tendon insertion. Qualitative description oftendon morphology is partly subjective, which may explainsome of the differences in our description of medial tricepstendon anatomy compared with those of prior studies.11

However, our tendon morphologic findings were consistentacross specimens and accurate as described.

Conclusion

Both the qualitative anatomy and quantitative anatomyof the triceps insertion have been described. The lateraltriceps expansion is a consistent anatomic finding witha width that is approximately 70% of the width of thecentral triceps tendon. The central triceps tendon hasa distinct, thickened medial edge that is confluent with,rather than separated from, the central tendon. Thetriceps insertion has a broad medial-to-lateral insertionthat expands in the proximal-to-distal dimension andcorrelates with the size of the olecranon. Knowledge ofthis anatomy will help the surgeon optimize surgicalapproaches and triceps repair techniques.

Disclaimer

The authors, their immediate families, and any researchfoundations with which they are affiliated have notreceived any financial payments or other benefits fromany commercial entity related to the subject of thisarticle.

Figure 8 Footprint of triceps tendon insertion. Posterior view ofa left olecranon after removal of triceps tendon. The border of thetriceps tendon insertion has been highlighted, showing the dome-shaped appearance of the insertion. Dashes, Olecranon tip.

404 J.D. Keener et al.

21 mm

13 mm

Biomécanique

Versier G

Muscles de la flexionMuscles de la flexion

Biomécanique de laBiomécanique de laflexion-extensionflexion-extension

1- Biceps brachial1- Biceps brachial

2- Brachial antérieur2- Brachial antérieur

3- Long supinateur3- Long supinateur

Muscles de lMuscles de l’’extensionextension

1- triceps brachial1- triceps brachial

2- 2- anconéanconé

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Muscles supinateursMuscles supinateurs 1 1 –– Biceps brachial +++ Biceps brachial +++

–– 2 chefs2 chefs–– Innervé par le MCInnervé par le MC–– ContractionContraction

Place la tubérosité bicipitale en avant et enPlace la tubérosité bicipitale en avant et endedansdedans

Action flexion du coudeAction flexion du coude

2 2 –– Long supinateur Long supinateur–– Innervé par radialInnervé par radial–– Plus fléchisseur du coude que supinateurPlus fléchisseur du coude que supinateur

3 3 –– Court supinateur ++ Court supinateur ++–– Innervé par le radialInnervé par le radial–– Contraction:Contraction:

rotation externe de l rotation externe de l’’Ext. Sup. du radiusExt. Sup. du radius Donc rot. Ext. Amplifiée de lDonc rot. Ext. Amplifiée de l’’Ext.Inf.Ext.Inf. du du

radiusradius

Muscles pronateursMuscles pronateurs

1- Rond pronateur +++1- Rond pronateur +++–– ÉpitrochléenÉpitrochléen–– Innervé par médianInnervé par médian

2- Grand Palmaire2- Grand Palmaire–– Plus fléchisseur que pronateurPlus fléchisseur que pronateur–– Innervé par médianInnervé par médian

3- Carré pronateur ++3- Carré pronateur ++–– Innervé par médianInnervé par médian

Biomécanique

Versier G

Physiopathologie

Maffuli JBJS 2005

Cadre nosologique

Tendinopathies

Corporéales ou d’insertion

Aigues ou chroniques

Non rompues ou rompues

Sémiologie: biceps

Facile Le signe du crochet

(only) Male in the 40’

Dominant arm,

Forceful flexion at 90° or forced extension on a contracted biceps

Violent trauma +++ (corticoids)

Clinical diagnosis

Imagerie : biceps

Rupture récente: pas nécessaire, diagnostic clinique Rupture ancienne: IRM mais finalité thérapeutique?

Peu utile en pratique:

Le diagnostic est cli

nique

Imagerie : triceps

récente chronicisée

Traitement médical Ou Chirurgical

Traitement chirurgical Risque +++ tendon

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Technique chirurgicale: biceps Technique de réparation -1 ou 2 incisions : - Grewal JBJS 2012 : (prs) pas de différence clinique mais plus de complications (mineures) pour le 1 voie -Chawan AJSM 2008 (SR) : 2 incision: moins de force, moins de rotation, complications id.

Technique palliative -  Fixation du moignon sur le

brachialis. -  => flexion -  Greffe tendineuse -  =>flexion + Supination

Bourses synoviales du coudeBourses synoviales du coude

1- Brachial antérieur1- Brachial antérieur

2- Biceps brachial2- Biceps brachial

3- Bourse séreuse 3- Bourse séreuse bicipito-bicipito-radialeradiale

4- Triceps brachial4- Triceps brachial

5- Bourse sous tendineuse5- Bourse sous tendineusedu tricepsdu triceps

6- Bourse 6- Bourse intraintra tendineuse de tendineuse dell’’olécraneolécrane

7- Bourse sous cutanée7- Bourse sous cutanéeolécranienneolécranienne

Technique chirurgicale: biceps Fixation distale

Rééducation: -3 semaine passive pure / 3 semaine active >6 semaines: actif contré >12 semaines: travail en force

Baratz JHS 2010

Technique chirurgicale: biceps Fixation double incision

Vanhess JOTR 2012 Greenberg JSES 2003

Résultats: -récupération de la

force en flexion et en supination

Résultats: biceps

Complications: -36% -10% de reprises -neuro sensitives (26%) -neuro motrice (4%) Ø  4 sem !!! -ossifications

Cain JHS 2010

BCI: Voie antérieure

NIP: voie postérieure

Technique chirurgicale: triceps

Technique: -Directe -Traitement des

lésions osseuses associées

Rééducation: -3 semaine passive pure / 3 semaine active >6 semaines: actif contré >12 semaines: travail en force

Résultats: biceps

Quand ?

J0 J 10 J21

Complications

41% 38% 24%

Kelly JBJS 2000

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Résultats de l’abstention chirurgicale: -Perte de force en flexion moyenne 16% -Perte de force en supination moyenne 26% -40% crampes du biceps

Mais -Reprise du travail à l’identique en 12 semaines -Aucune différence en force ( F ou S)

Résultats: biceps

Baratz JHS 2010

Freeman JBJS 2009

Nesterenko JSES 2010

Traitement des tendinopathies d’insertion

Maffuli JBJS 2005

Traitement des tendinopathies corporéales

Maffuli JBJS 2005

Indications: biceps

Age du patient

Activité professionnelle

et sportive

Ancienneté des lésions

QUAND?

QUI?

COMM

ENT?

Tendinite chronique: échec du traitement médical

Rupture traumatique: indication chirurgicale

systématique

Indication chirurgicale: triceps

TOM: -Pathologie rare -  Triceps = Chirurgie -  Biceps = Discussion

Conclusion

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Merci