Proximal biceps rupture: management of an unusual injury in an arm wrestler

Abstract

Arm wrestling may cause unusual injuries, which may require operative repair in the sporting individual. Injury to the proximal biceps as a consequence of arm wrestling has not been reported previously. The diagnosis and treatment of a 36-year-old man who sustained a proximal biceps rupture while arm wrestling and his operative management are described.A rm wrestling is a growing sport that requires strength, effective technique and rapid speed of reaction. The most commonly occurring serious injury in participants of this sport is spiral fracture of the humeral shaft. [1][2][3][4] Fracture separation of the medial humeral epicondyle 5 and fractures of the olecranon have also been reported. 6 The mechanism of rotation, coupled with the powerful unopposed contractions of the biceps, is thought to be responsible for many of these injuries.As far as we are aware, injury to the proximal biceps as a consequence of arm wrestling has not been reported previously. We describe an unusual case of proximal biceps rupture in an arm wrestler and describe his subsequent management.Rupture of the proximal biceps tendon occurs in 90-97% of all biceps ruptures and almost exclusively involves the long head. They tend to occur in people aged .50 years and are often associated with rotator cuff tendonitis.7 Rupture of the long head tendon is uncommon in competitive and recreational athletes. A 36-year-old man presented with pain in the anterior compartment of his arm, worse on flexion and supination with a clear long-head rupture of the biceps. The onset of this pain coincided with an episode of competitive arm wrestling. After discussion, he elected to have the tendon repaired to allow his return to the sport.After confirmation of the diagnosis, the biceps lesion was repaired using the technique described by Wiley et al. 10TREATMENT AND SURGICAL TECHNIQUE At arthroscopy, no remnant of the biceps was seen and the arthroscope was removed. A 2-3 cm incision was made along the inferomedial border of the pectoralis major. Blunt dissection between the internervous plane of the pectoralis major and conjoint tendons was next undertaken down to the anterior surface of the humerus. The biceps tendon stump was identified and a number 2 Fiberwire (Arthrex, Naples, Florida, USA) whipstitch was inserted. The tendon stump was then secured to the humerus by means of a Biotenodesis screw (Arthrex). POSTOPERATIVE CARE AND IMMOBILISATIONThe patient was immobilised for 2 weeks in a polysling, at which point physiotherapy was started with a passive range of motion exercises for 2 weeks and an active range of motion exercises for the next 4 weeks. At 6 weeks, lifting of weights ,5 kg was permitted, and at 12 weeks lifting of weights was unrestricted. This patient had no postoperative complications and he had regained the full range of motion and strength by 3 months.

Long head of the biceps tendon rupture in professional wrestlers: treatment with a mini-open tenodesis

“…19 Less commonly, ruptures have been reported in weight lifters at the musculotendinous junction and within the muscle belly. 5 Recently, the diagnosis and treatment of a 36-year-old man who sustained a proximal biceps rupture while arm wrestling and his operative management have been described; 18 in addition, there is a report of an isolated LHBT rupture in an underhand thrower, as a result of the increased bicep muscle activity or increased tendon excursion in the windmill-pitching motion. 9 While nonoperative treatment is often successful, operative treatment may be required for those patients who do not achieve acceptable pain control or functional recovery.…”

Verletzungen nach Armdrücken – Bericht über 11 Patienten mit unterschiedlichen Verletzungsmustern

“…al beschrieben [6]. Weitere Verletzungen nach Armdrücken sind unter anderem Frakturen des medialen Epicondylus [2], Ruptur der Subscapularis-Sehne [8], Ellenbogenluxation [5], Olecranonfraktur [9] sowie proximale Bizepssehnenruptur [4]. Wir berichten in diesem Zusammenhang über Verletzungen bei 11 Patienten nach Armdrücken.…”

Atypical tear of the long head of the biceps tendon in a young male adult

“…LHBT ruptures at atypical anatomical sites and in younger active patients are reported infrequently. Case reports of LHBT ruptures in younger patients have been documented during weightlifting,4 arm wrestling,5 softball6 and water skiing 7. Although it is unusual to sustain an LHBT in a younger cohort of patients, risk factors including anabolic steroid abuse may accelerate the natural history of tears 4.…”