A junior rubgy player came after competition with a painful Rt 5th finger. He had pain at the side of the Metacarpo-phalangeal joint after feeling a sharp pain and loss of power after 'losing grip' of an opponent's shirt.
He suffered from torn collateral ligament and would benefit from buddy taping or splinting over the next 4 to 6 weeks.
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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
20 world class teams will be engaging in a sport which requires agility, power and strategy in the IRB Rugby World Cup 2007 from the 7th September 2007 to 20th October 2007. 3 teams (USA, Canada, Argentina) represent the Americas, 9 teams (England, France, Georgia,Ireland, Italy, Portugal, Romania, Scotland, Wales)represent Europe, 2 teams (Namibia, South Africa) represent Africa and 6 teams (Australia, Japan, Fiji, New Zealand, Samoa and Tonga)represent Asia-Oceania divided into 4 pools (A-D). 
The Pool Stages will be held from 7th September 2007 to 30th September 2007 and the Knockout Stages will be held from the 6th October 2007 to 20th October 2007 after a 5 day break. Matches will be played in 12 different venues in France (Bordeaux, Lens, Lyon, Marseille, Montpellier, Nantes, Paris, St Denis, St Etienne and Toulouse) and UK (Cardiff, Edinburg).
Which team will make it to the finals on the 20th October 2007 in St-Denis?
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