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Orthopedic Surgeon - Board Certified
Fellowship Trained in Knee and Shoulder Surgery
Shoulder and Knee Specialist, Sports Injuries, Worker's Compensation
Voted "Best Doctors" 2012, 2011, 2010, 2009 St. Louis Magazine
ASK THE EXPERT - FEBRUARY 3, 2012
Dear Dr. Milne,
Our 25 year old wrestling coach was demon- starting a move for our high school wrestling team and felt a pop in his left elbow. Now he has pain and bruising in the front of his elbow. What does this mean? Elena, 29, Wildwood
He probably ruptured his biceps tendon. An orthopedic evaluation is needed quickly and given his young age, surgery is likely his best option.
The biceps muscle has two tendons at the shoulder and also crosses the elbow joint. While this muscle helps flex the elbow as in “biceps curls”, it is even more important in supination (the act of rotating the palm up, similar to the motion of turning a doorknob or using screw- driver). The insertion of the biceps cross the elbow joint and attach to the radius bone just below the elbow crease – this is the tendon we are concerned about.
Eccentric loading is a primary cause of tendon rupture. As we age, the biceps tendon seems to rupture more commonly. Diagnosis is often made by patient history and physical. Bruising in the front of the elbow (ante- cubital fossa), weakness in supination, and a palpable or audible pop are signs and symptoms consistent with a biceps tendon rupture.
Plain x-rays are usually normal (negative) and an MRI is often ordered to confirm the diagnosis and evaluate the location of the rupture. Most ruptures occur right off of the bone.
Once diagnosed, surgical and nonsurgical treatment options are discussed with the patient. Older patients, non-dominant arm injuries and less active individuals may elect for nonsurgical options such as physical therapy, icing and rest. Most people have very little functional deficit and may only notice a cosmetic deformity and weakness in supination.
Surgical treatment is often recommended for younger and more active patients (athletes, workers, weightlifters). Dominant arm injuries are surgically treated at a higher rate as well.
Newer techniques using fluoroscopic visualization allow for a direct attachment of the tendon to the bone through a small “buttonhole” incision. This technique allows for early mobilization and lower rates of stiffness and loss of motion than previous procedures.
Most surgeons want to repair this problem within 14-21 days of the injury to insure the best results. Visit www.STLsportsdoc.com for surgical animation of this and other common orthopedic procedures.