Summary

This study aims to show the potential impact of sudden restart of intense manual work after a period of inactivity due to COVID19 lockdown. Specifically, we saw an increase in the number of biceps tendon tears compared with the cases before COVID19. Likewise, we report our results after primary surgical repair of 144 biceps tendon tears in our usual practise during the years 2018, 2019 and 2020.

Abstract

Introduction

For many, COVID19 pandemic has stopped the earth from spinning. Surgeons, patients, workers and athletes have been forced to cease our usual routine to lockdown. As a consequence of these new normality, new problems appeared. Whereas we could find a few studies suggesting a gradual return to the activity in order to avoid injuries in elite athletes, there is no mention in the literature regarding the much more frequent and unnoticed manual workers, who have shift from a sedentary situation to a high demand activity with no previous readaptation.
In our context of a monographic labor trauma center, we diagnose and repair distal biceps tendon tears (BTT) routinely. The matter of this study is to report our results in the context of a noticeable increase in BTT cases right after the COVID19 lockdown, when comparing with similar periods before COVID19 pandemic.

Methods

We developed a transversal retrospective cohort study reviewing all patients suffering BTT at work and being treated in our center the years 2018, 2019 and 2020. Our patients are manual workers, between 18 and 65 years old and mostly with no comorbidities.

Results

We report a total of 144 BTT, being 124 (86.1%) of those patients high demand manual workers. 109 BTT (92.4%) were treated as an acute tear with primary repair with sutures and anchors, and 9 BTT (6.3%) were repaired chronically adding Achilles tendon allograft with similar anchoring technique.
When looking at the temporal distribution of the cases, we find a cluster of 37 BTT (25.7 %) at the second semester of 2020, which is right after the lockdown in our country. These are more cases than any other semester of the years 2018, 2019 and 2020, that have an average of 24 cases (16.6%) per period. The patients of all these periods had similar characteristics, as described above.
The only complications we had are: 2 posterior interosseous nerve transitory injury (1.4%), 1 lateral antebrachial cutaneous nerve permanent injury (0.7%), 1 Complex Regional Pain Syndrome (0.7%) and 2 cases of BTT recurrence (1.4%), which have been properly repaired. As our main outcome 141 of our patients (97.9%) have return to their usual job with an average of 142 days off-work.

Discussion

In one hand, we report a higher incidence of BTT after an off-work period of those patients due to COVID19 lockdown.
On the other hand, we purpose the primary surgical repair in BTT as a safe, fast and efficient treatment for high and low demand manual workers.

Conclusion

Our findings suggest a readaptation is needed when returning to work after a long period of inactivity in manual workers. Being the first report that quantifies this issue, stronger studies may be conducted in order prove this correlation.
At the same time, we report our good results after acute surgical repair of BTT, being this a valid first choice treatment in our population.