Torn Bicep

[lost_arrow]

I am looking for information from anyone who has experienced a torn biecp - did you have surgery? pt? rest? decreased strength?

 

thanks - trying to decide on surgery soon.

[jonah]

How do you know you tore it? Is it a torn muscle or did the biceps head detach? My dad's whole bicep ripped off, and he didn't do anything about it surgically, just did pt, and now he has full strength again (the brachialis apparently can compensate). Of course, it looks very odd. Same thing happened to John Gill, but he had surgery and was doing one-arms again in 6 months; he was over 50 at the time, too.

[lost_arrow]

tore it during pt - one of the bicep heads did detach (with the resulting weird bulge now at the bottom of my arm by my elbow.

 

had an mri done and am still waiting for the results - saw one surgeon so far, he suggested pt and time and i am going to two more docs next week - the docs thus far don't seem to understand climbing (thus the search for other climbers who have experienced this)

[Snowpuppy]

Ouch, have you checked out any of the articles on the bodybuilding sites? It might help you out.

[colt45]

In terms of climbing, it is worth noting that the biceps is only a weak flexor at the elbow. The brachialis (mentioned above) is the primary flexor of the elbow. You just can't see it b/c it's under the bicep.

 

As I understand it, the primary function of the biceps is actually supination (ie rotating your hand away from midline) and it is more of an "accessory" flexor, and really is only involved in flexing at all when your hand is supinated (eg doing pull-ups with your palm facing toward you).

 

Your orthopedic surgeon would probably know what is best. Reattaching a tendon would certainly involve potential complications, and the key question is whether there would be a significant gain in function in the end after the risks, expense, and downtime.

[mneagle]

Don't just go to an orthopedic surgeon, make sure it's a specialist in sports medicine. Contacting the University's gymnastics team trainer and asking who they recommend may be a good idea. Of all the mainstream sports, gymnastics seem to be the most like climbing to me.

[layton]

In terms of climbing, it is worth noting that the biceps is only a weak flexor at the elbow. The brachialis (mentioned above) is the primary flexor of the elbow. You just can't see it b/c it's under the bicep.

 

As I understand it, the primary function of the biceps is actually supination (ie rotating your hand away from midline) and it is more of an "accessory" flexor, and really is only involved in flexing at all when your hand is supinated (eg doing pull-ups with your palm facing toward you).

 

Dude your biceps info is total BS. The bicep helps the supinator m. supinate, but is the major forearm flexor. Put your hand on your biceps and feel for yourself. The brachialis is also a forarm flexor, but not as big as the biceps.

[lost_arrow]

thanks for the info everyone! please keep it coming! m layton - just curious if you are involved in the medical community? like i said, i will be seeing two more docs this week - but any experiences from other climbers would be great - i am definitely torn (no pun intended) between surgery or no surgery...

[colt45]

The information I mentioned is present in every anatomy textbook I have seen. In the below links, you can sort of see how the brachialis has a mechanical advantage relative to the biceps. Flex your arm with your palm away from your body and you will note that the biceps doesn't really contract that much...then rotate your wrist back and forth with your arm flexed and note that the biceps now contracts noticeably...

 

Here are schematics of the muscles, with a brief description of their function:

 

brachialis

 

biceps brachii

 

And, here is info on biceps tendon rupture from Campbell's Operative Orthopedics (10th ed., 2003). Note that supination is the only somewhat consistent deficit in the absence of surgical repair (although one study found an 8% long-term loss in elbow flexion strength).

 

------------------

According to Gilcreest, over 50% of all ruptures involving the biceps brachii muscle occur through the tendon of its long head. He also noted that an acute traumatic rupture of this tendon occurs most often when a person is raising a weight of 150 pounds (68 kg) or more; the exact force required depends on the strength of the tendon. The rupture usually is more or less transverse and is located either within the shoulder joint or within the proximal part of the intertubercular groove. Most of the remaining ruptures occur at the musculotendinous junction or at the attachment to the glenoid. (A few ruptures occur through the tendon of the short head, the muscle proper, or the distal tendon of the biceps muscle.)

 

According to Watson-Jones, surgical repair of a rupture of the tendon of the long head is not necessary but usually is desirable for both functional and cosmetic reasons. Soto-Hall and Stroot studied the power of flexion of the elbow and abduction of the shoulder with the arm in external rotation in patients with rupture of this tendon. They found that, when a rupture was recent, the power of flexion of the elbow was about 20% less than that of the opposite side and the power of shoulder abduction with the arm in external rotation was about 17% less that of the opposite side. However, when a rupture was seen late, no appreciable weakness was noted in either flexion of the elbow or abduction of the shoulder. They concluded that, except for young people, conservative treatment is indicated for most patients with rupture of this tendon.

 

Warren, using a Cybex isokinetic dynamometer to evaluate 10 patients, found no significant loss of elbow flexion power after rupture of the biceps brachii but did find an approximately 10% loss of supination power. Mariani et al. compared their results with operative and nonoperative treatment of ruptures of the long head of the biceps brachii. Biomechanical testing showed a mean loss of 21% of supination and 8% of elbow flexion strength in patients treated nonoperatively; those treated operatively had no measurable loss of strength. We reviewed 43 ruptures in 42 patients, all but one of whom was older than 50 years of age. Half the ruptures occurred with minimal or no trauma, and over half the patients had a positive impingement sign at initial evaluation. Physical examination and Cybex testing of 19 patients revealed no differences in elbow flexion power in patients treated nonoperatively and those treated operatively; the operative group had slightly better supination power.

 

We prefer operative repair of proximal biceps tendon rupture in young, active patients who are not willing to accept the deformity or slight weakness of supination. Occasionally, repair is indicated in a middle-aged patient whose profession, such as carpentry, requires full supination strength if the patient believes the time out of work is outweighed by the slight increase in supination power gained by operation.

--------------------------

 

The book then goes into surgical details, which is not particularly interesting. But they do note that post-surgically, "participation in sports should be delayed for at least 12 weeks."

 

 

[layton]

Fine. When the forearm is pronated the brachialis is the major flexor of the forearm, but that's not a very practical description since flexing the forearm in that position is severly limited by the medial boundaries (ie, your arm hits your torso after like 10 degrees of flexion).

 

The short head of the biceps combines with the long head so both flex the forearm when supinated. Flex your forearm in the anatomical position (supinated) and you will feel the biceps shorten. Since it's a much bigger muscle, it's gonna have a lot more stregnth, thus it's the major flexor when the forearm is supinated. The brachialis also helps flex the forearm and is an intrisic forearm muscle since it only crosses one joint. It helps the biceps flex the forearm by pulling on the ulna which not only adds to flexion, but stabilizes the proximal radial ulnar joint to keep the forearm stable.

 

blah blah blah. anyways this is all kinesiobabble and doesn't really matter. I'm sure the brachialis will take over just fine w/a torn biceps, but the motion won't be as strong. Also putting in ice screws won't be any more challenging unless bike mechanics start making them and we have to turn the things to the left. Removing screws may be more difficult.

[colt45]

Also putting in ice screws won't be any more challenging unless bike mechanics start making them and we have to turn the things to the left. Removing screws may be more difficult.

 

Or you could place screws with your left hand and remove them with your right hand, thus avoiding forceful supination altogether!!

[lost_arrow]

thanks everyone!

 

after seeing the other docs i have decided to wait two months and see how the rehab progresses - the docs want to see how my climbing goes and then make a decision - sounds good to me.

 

thanks again for providing a great community