Distal biceps ruptures – a ticking time bomb?

By Val Jones

Working in a Regional Trauma Centre, we’re used to seeing lots of soft tissue injuries on a regular basis. But the one that was considered more unusual when I first started working at the Shoulder & Elbow Unit in Sheffield over 20 years ago was the acute distal biceps rupture. Previous literature both on UK and US populations describe it as a rare injury, with an incidence of 1.2 to 2.6 per 100,000 person years [1,2]. This equated to seeing and operating upon between 10 and 12 patients per annum for the Sheffield population of  approximately 750,000 during the first few years of the millennium.

However, in the last decade there has been an explosion, quite literally, in the number of patients attending our unit with a distal biceps rupture. Our team now on average sees up to 40 cases per year - over a 300% increase - over a 20 year period. These figures made me question what was driving this increase and was this just a regional trend, or something that other orthopaedic units were seeing? Also, what are the implications for an already struggling healthcare system to cope with an increased demand for surgery, imaging, resources, and post-operative rehabilitation?