Friday, 28 September 2007

Right Biceps Tendon Rupture

Mr K was tugging onto the rope in a tug-of-war when he suddenly felt a snapping sensation with a sharp pain in his right arm a month ago. He thought he had torn his muscle but after a few weeks he seemed to have recovered fully except for the bulge in his right arm (see photo and compare with the normal left arm). He told me that he used to work out regularly at the gymnasium and hence had a much bigger arm. It looks as if it had shrunk significantly in size.

He only came to see me today and I examined his arm and found the 'popeye sign' and smaller biceps muscle with reduced power against resisted flexion. His forearm supination and pronation seemed as strong as the left. His long head of biceps was not palpable suggesting that it was ruptured completely. He only had mild pain with flexion of a fully extended elbow. He reminded me of an older case of a rugby player who had a similar biceps tendon rupture a few years earlier.

I referred him to an Orthopaedic Surgeon who suggested an MRI to detect the location of the edge of the long head. We agreed that he probably needed surgery if he wanted full function and active sports participation. If he was much an elderly patient, some physicians prefer a conservative non-surgical approach.

According to Klonz et al, ruptures of the long head of the biceps are commonly caused by degenerative changes within the tendon. Non-operative treatment gives good results, the loss of power regarding elbow flexion and supination amounts to only 8-21%. Refixation may be indicated for cosmetic reasons and offers a small but evident improvement of flexion and supination power. Deformity of the slipped muscle can be corrected effectively. Residual complaints after conservative treatment often result from associated subacromial problems.

Useful Links:-
Arthroscopic-assisted biceps tenodesis for ruptures of the long head of biceps brachii
Functional results after suture repair in ruptures of the long biceps tendon with special consideration of subacromial impingement
MRI or MR arthrography: a useful tool for evaluation of the biceps tendon rupture
Proximal and distal ruptures of the biceps brachii tendon

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