Biceps partial tear

A bodybuilder felt a snap in his biceps muscle while doing his upper body workout in the gym. He immediately felt a sharp pain and weakness in the arm adjacent to the elbow. He discontinued his training session for the day.

A day after the incident, he could not extend his elbow fully and had pain at the myotendinous junction of the biceps muscle. The was a noticeable defect in the muscle compared to the other side. He was advised rest from upper limb exercises and RICE treatment was given. Kinesiotape was applied to prevent elbow extension.

A week after the incident, there was significant bruising seen and the pain had mostly subsided. He was still advised against full extension of his elbow.

At day 10 post-injury, there was some bruising as the athlete started some minimal biceps curled in flexion. He was advised to do just isometric exercises and ice after exercises.

At 14 days post-injury, the site of injury was pain-free and he had full range of motion. He required careful monitored strengthening of the upper limb for at least 4 t0 6 weeks while protecting the biceps muscle.

Wrist (Radiocarpal ) Impingement and mild arthritis

Mr White (not his real name) is a 120kg weightlifter in his 20s who suffered from right wrist pain since 2 weeks duration. Prior to his competition he came to see me as the pain was preventing him from lifting beyond maximal capacity during 'clean and jerk'. His earlier X-ray did not show any fracture or osteophytes.

I examined his wrist yesterday morning only to find tenderness and slight fullness (synovitis) over the lunate bone in his right wrist. Forceful wrist hyperextension ellicits the same pain he experiences doing 'cleans'. Resisted extension was unaffected (ruling out extensor digitorum communis tendon involvement) He would need to rule out a lunate stress fracture (Radioisotope Bone Scans would be useful). He did not have any scaphoid bone tenderness although it is more common amongst weightlifters.

While awaiting his Radioisotope Bone Scan to rule out a stress fracture or Kienbock's Disease he would need to avoid doing 'cleans' and reduce the load of lifts. An ultrasound scan would be able to determine the extent of joint and tendon involvement with a musculoskeletal radiologist. Meanwhile, he should not participate in competition as it could worsen his condition. He would benefit from daily low frequency ultrasound (Exogen) for another 2 - 4 weeks. If symptoms persists he would need to be reviewed. MRI Scan could be an option then.

Interesting links:-
Wrist arthritis
A possible complication: Kienbock Disease