Distal bicep tendon rupture

[r2473]

Damn!! Suffered a complete rupture this morning of my bicep tendon in my elbow. I just hit a normal forehand and it snapped. But i heard a "pop" earlier this week in the gym,so i think that resulted in a partial tear.

Will need surgery to reattach. Probably ~6 months for a full recovery.

Anyone else ever do this? If so, can you let me know what i'm in for?

Here's what i'm in for, except mine will be done immediately so i won't need the graft. and the procedure is a bit different now.

http://www.ncbi.nlm.nih.gov/pmc/arti...320378/?page=1

http://www.youtube.com/watch?v=s3j9oehA-sk

[mikeler]

I'm very sorry this happened to you. While I cannot help, I do hope you can recover sooner than the expected time they gave you. Good luck.

[El Diablo]

Happened to a surgeon I know, he now plays tennis again though oddly collects disability, claiming he can't operate due to weakness in the arm. His tennis seems okay, though.

[Say Chi Sin Lo]

You heard a pop lifting weights, suspected a partial tear, and you go on to play tennis?



Candidate, no actually, the award goes to you for idiot of the year.

[El Diablo]

^^ actually, it sounds like it was only in hindsight that the partial tear was suspected. Our bodies sometimes creak a bit as we get older, we don't always think it's something to be concerned about.

[r2473]

I called the orthopedic center to make an appointment the day it happened. they scheduled me out 2 weeks. i also did my normal gym routine on friday with no issues or concerns. Ortho probably didn't have much of a concern because of how rare a distal rupture is.

There's no real pain associated with this. The partial tear was just the popping sound, but I didn't feel a thing. When it snapped yesterday, it felt a bit weird, but not really painful. (This is actually not what I meant. You get a quick burst of pain when the tendon snaps. It almost feels like an electrical charge. But after that happens, there isn't much additional pain. Right now, I just feel a dull pain, but I can use my right arm just fine. Just can't support much weight and it hurts to move it in certain ranges of motion). I knew what had happened almost right away. My opponent and the few people watching at first thought I had broken a string. Then they figured I just felt a little pain in my arm or something, but they all expected that I was going to jump back out in play. In fact the guy running the thing said he'd give me 15 minutes if I need it. Given my almost non-reaction, nobody thought I had done anything too serious. There wasn't any bleeding, swelling, bruising. Really nothing. It even takes a little while for your bicep to move up you arm more toward you shoulder. Even now its not real noticeable.

reading a bit more on this, i suspect that I actually caused damage last monday playing tennis. When I went to hit a forehand, I misjudged the ball due to a gust of wind and nearly missed it. It was a deep court floater and I swung pretty much as hard as I could at it. When it held up, I made an unconscious adjustment by reaching for the ball and straightened my arm. I felt quite a shock in my arm, but didn't think much of it. I just kept playing and everything was fine.

The next day in the gym I was doing back levers (which I've been doing for over a year). This puts tremendous stress on your elbow. I heard the "pop" and thought I had torn the tendon, but hadn't. At least it didn't appear I had. I finished my gym routine that day too with no real issue or discomfort. I talked to ortho as well as a few friends and nobody seemed too concerned. Friday in the gym was fine. Hit several balls on saturday before snapping it.

I wonder if ortho could have seen anything if I had gotten in sooner. I guess it depends on what had already happened. Also I have to wonder how much damage had already been done and if it could have healed non-surgically.

In hindsight, playing tennis was obviously a bad idea, but it wasn't quite as obvious 24 hours ago. At least not to me.

As Diablo says, from what I read, it looks like there is no reason to believe I won't make a full recovery. Its a pretty "simple" reattachment. Guess it beats having TE, shoulder, back etc. problems.

[r2473]

Originally Posted by El Diablo

Happened to a surgeon I know, he now plays tennis again though oddly collects disability, claiming he can't operate due to weakness in the arm. His tennis seems okay, though.

As rare as this injury is, oddly enough, there was a guy at the court that tore his distal bicep tendon playing basketball some years earlier. He is now about 55 or so I'd guess. He told me pretty much what I've read. About 6 months after surgery, I should be 100%.

When he was looking at my arm after it happened, he didn't believe I had torn it because he said his bicep really sort of flopped to the side and mine really didn't do anything right away. But I did the "hook test" to try to find my tendon and there wasn't anything there, so it was pretty obvious what had happened.

We figured that since I lift weights a bit, maybe I have developed enough supporting strength to compensate some. All that has happened now is that the bicep has retracted slightly from the elbow. I just have a rather dull pain in that area. Loss in strength. Hurts a bit to turn my hand palm up. But I'm not really too uncomfortable at all.

[Chas Tennis]

From the Manual of Structural Kinesiology, C. Thomson & also an Anatomy reference -

The biceps inserts at two locations distally: 1) Tuberosity of the radius and 2) the bicipital aponeurosis. [Aponeurosis - flattened tendon into sheath]. I am not clear as to how the aponeurosis connects - diagrams do not show it inserting on a bone in the forearm but more connecting to more tendon or fascia. ?

In any case, the biceps inserts at two connections in the forearm. That may be why your biceps did not pull up too much. Also, the fellow with the biceps injury might have injured the other tendon insertion. Ask your Dr where the rupture is.

The reference says that for various arm orientations "the forearm should be fully pronated to achieve maximal lengthening of the biceps brachii." I interpret that to imply that pronation might stretch the tendon and excessive pronation might stress or injure it. Were you doing any curls with an 'easy bar' that might have put your forearm in pronation while lifting weights? It probably could also be stressed by a violent reversal in direction, coming out of a backswing?

[scotus]

I wish you a full and as-quick-as-possible recovery.

[Posture Guy]

Dang, man, crappy news. Really sorry to hear of it and I wish you a successful surgery and a quick and full recovery.

Post-surgically, perhaps wrapping it in bacon might speed things along?

[Chas Tennis]

Originally Posted by r2473

..............................................
.................................................. .................................................
reading a bit more on this, i suspect that I actually caused damage last monday playing tennis. When I went to hit a forehand, I misjudged the ball due to a gust of wind and nearly missed it. It was a deep court floater and I swung pretty much as hard as I could at it. When it held up, I made an unconscious adjustment by reaching for the ball and straightened my arm. I felt quite a shock in my arm, but didn't think much of it. I just kept playing and everything was fine.

The next day in the gym I was doing back levers (which I've been doing for over a year). This puts tremendous stress on your elbow. I heard the "pop" and thought I had torn the tendon, but hadn't. At least it didn't appear I had. ...............................Hit several balls on saturday before snapping it.
..................................... Also I have to wonder how much damage had already been done and if it could have healed non-surgically.
........................................

Speculating, maybe your violent tennis stroke played a part? The Manual of Structural Kinesiology - on stretching the biceps - The biceps may also be stretched by abducting a fully extended elbow to 70 to 110 of shoulder abduction. ?

It is complicated because the biceps is a 3 joint muscle - shoulder, elbow, and radioular. I guess if all joints are oriented to stretch dynamically and forcefully it would put a lot of stress on one of the tendons. (The above reference is very useful for understanding the muscles, joints and their motions.)

The top of the biceps connects above the shoulder at two originations. I spoke to two players who had had complete ruptures to one of these tendons originations. Neither had had surgery and had loss of strength. I played both and they did not seem too impaired. ?

One described how his biceps had balled up in his arm, an obvious and serious injury. He had waited too long before seeing a Dr - I believe it was just a very short time, just days after the injury. ? He was told that he could no longer have it reattached. ? What he told me regarding the short window for surgery does not seem reasonable but that is what he said. ? I would consider this possibility for any tendon injury and see a Dr immediately. I don't see how any completely ruptured tendon can heal without surgery, do you?

[charliefedererer]

What rotten luck.

Best wishes for as quick a recovery as possible.

[r2473]

Originally Posted by Chas Tennis

One described how his biceps had balled up in his arm, an obvious and serious injury. He had waited too long before seeing a Dr - I believe it was just a very short time, just days after the injury. ? He was told that he could no longer have it reattached. ? What he told me regarding the short window for surgery does not seem reasonable but that is what he said. ? I would consider this possibility for any tendon injury and see a Dr immediately. I don't see how any completely ruptured tendon can heal without surgery, do you?

I got in this morning. Scheduled for surgery tomorrow. Here's the deal.

1) You don't have to have surgery. Other things will compensate. You can get along fine. But, you will lose a lot of strength and some range of motion and flexibility. Basically, if you are young like me, you get it reattached surgically. If you are old, they don't bother.

2) Now, if I had torn one of the two tendons connecting the bicep to the shoulder, they would not do surgery. Apparantly this is failry common. The resident I was talking with said it happened to John Elway for example and they didn't do surgery on him.

3) As far as the window, if you wait to long, the area starts to heal, meaning the tendon gets scarred over so you can no longer just pull it down with forceps to the reattachment point. You need to get a graft. And yes, it also starts to retract, so it is also harder to grab. I imagine if you are too old, they have even more incentive not to do the surgery.

4) The big danger with this surgery is that they could hit the big nerve in your arm. Then you couldn't move your fingers anymore. That's the major risk anyway. The other big one is that the bone could grow into the tendon and screw things up. I think this happened more in the past, but is not so common now.

5) The procedure is the single incision procedure. Nobody does the double incision anymore. I provided a link to that above I believe. You can watch the procedure on youtube.

6) In terms of healing, it takes a few weeks before you start moving your arm / fingers / shoulder, etc. You slowly get motion and strength back. You are back to 100% in 3-6 months. Apparantly the tendon does heal just as strong as if it was never unattached from the bone. Just like a bone break.

http://www.sportsmd.com/SportsMD_Articles/id/281.aspx

[Chas Tennis]

All sounds reasonable.

After your surgery look into the two distal insertions points that I mentioned. Of the two, maybe only the radius insertion tendon gets ruptured. ? The kinesiology book that I mentioned describes some other orientations that stretch the biceps & tendons. You might want to analyze your tennis and weight work to make sure your motions for both are not unusual in some way that stresses this injured tendon. (I'm always pitching high speed video for stroke analysis so let me know if you have any interested in that.)

I read that most tendon injuries occur at the tendon-bone interface or at the tendon-muscle interface as opposed to within the tendon. Don't know how true that view is. ? You might ask if your injury turns out to be one of those two cases.

Here's to a quick recovery.

[r2473]

I'd expect that the tendon simply came unattached from the bone. That is what happens nearly 100% of the time.

I think it was more of a freak event. When I swung the racquet my arm violently straightened as I reached for the ball I had misjudged due to the wind. Thing is, I was ****ed because the guy wall killing me. He sent a floater to the backcourt and I made up my mind to hit it as hard as I could. Out of anger more or less. So I was swinging as hard as I could and really didn't care if the ball was going in.

This by itself probably wouldn't have been enough. In fact, I continued playing for at least 30 more minutes with an issue.

But when I did the back lever the following day, I heard a "pop" (as I explained above). Looking back, those two events together were necessary. I don't think either by itself would have done it.

http://www.youtube.com/watch?v=t_lFhzHLIGI

Wow, there is an entire forum devoted to distal bicep tendon rupture:


http://tendonsurgeryinfo.com/distalbiceps/index.php

[tennisenthusiast]

Have you tried applying greased bacon to the area?

[Pacific lefty]

Hope your surgery goes well and you have a short and pain free recovery!

[r2473]

Looking at about ~6 months. I'm VERY risk averse, so I'll do all my rehab that the PT suggests, but won't go back to violent tennis swings or back lever hangs for ~ a year I'd guess. That's just how I do things. There are plenty of other things to be doing that aren't arm related. I want to be sure I'm 100% before gettng back. I hurt my shoulder a while back and took a full year (when I probably only needed 6 months or less). No shoulder surgery, but it took forever to heal. Which was fine.

Lucky I just have a desk job. I'm pretty sure I can still yell at people with a bum wing. I just can't smack them around anymore.

[Kevin T]

Originally Posted by r2473

Looking at about ~6 months. I'm VERY risk averse, so I'll do all my rehab that the PT suggests, but won't go back to violent tennis swings or back lever hangs for ~ a year I'd guess. That's just how I do things. There are plenty of other things to be doing that aren't arm related. I want to be sure I'm 100% before gettng back. I hurt my shoulder a while back and took a full year (when I probably only needed 6 months or less). No shoulder surgery, but it took forever to heal. Which was fine.

Lucky I just have a desk job. I'm pretty sure I can still yell at people with a bum wing. I just can't smack them around anymore.

For recovery, I would recommend the Paleo diet, 100,000 IU Vitamin D/day, as many supplements as you can afford and avoid any and all future vaccinations. Oh, and I hope you have an IPad

In all seriousness, sorry to hear this r2. Best of luck with the surgery and a full and speedy recovery. With my history of lumbar disc issues, I know how tough being on the sidelines can be. Take care and get well.

[r2473]

^^ I'm looking at it as a great excuse to read a few more books.

After the worst of it and I'm able to do "something", I'll probably up running mileage.

Eh, there are always things to do. I had been doing too much tennis and gym stuff anyway. Be good to take a break. I grew up a "nerd", so I'm right at home with the books.

On a funny note, the orthopedic doctor that looked at me today gave me a small lecture on how steroid use has been shown to be one of the things that cause a bicep tendon tear. He then asked me if I had ever done steroids. When I told him no, he continued on with a bit more of a lecture and asked me again.

I told him "thanks for the compliment"