Case Study: Elbow and Biceps Pain After a Fall

Discussion

The case image depicts a biceps tendon tear at the insertion on the radial tuberosity, which is an unusual presentation and may require surgery. The next best step would be to perform radiographic examination to rule out aversion, sling the impacted arm, and perform surgery in the most distal muscle tears and select long-head proximal tears.

The patient’s diagnosis, biceps tendon rupture, typically presents with sudden pain during forearm supination or elbow flexion (Table). A “pop” may be felt. The patient will have weakness in supination and elbow flexion, and may develop an arm deformity that can vary depending on which of the 3 biceps tendons have ruptured. The most common rupture is at the origin of the long head of the biceps in the glenoid fossa. In this type of rupture, the long head will ball up in the area of the distal humerus, resulting in a “Popeye”-looking arm. Rupture at the insertion on the proximal radial tuberosity is not as common; in this case, both of the 2 heads of the biceps ball up proximally, and an empty space is created where the distal biceps tendon was. The images demonstrate the appearance of an arm with this type of rupture.

Table. Biceps Tear Overview

From Emergency Medicine 1-Minute Consult.¹

Treatment for distal bicep tears is most commonly surgical as the entire muscle is involved and arm function is significantly worse. Treatment for proximal tears is often conservative without surgery. In such cases, the long head will atrophy and the short head will hypertrophy. Elbow flexion strength usually returns to near-normal, but supination strength will remain deficient. If this is not acceptable to the patient, surgery can be performed.

Case Conclusion

This patient underwent surgery and is recovering well with 85% restoration of his prior arm strength.

Brady Pregerson, MD, is an emergency physician at Cedars-Sinai Medical Center in Los Angeles and at Tri-City Medical Center in Oceanside, California.

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Reference

Pregerson DB. Emergency Medicine 1-Minute Consult Pocketbook. 5th edition, EMresource.org; 2017.

This article originally appeared on Clinical Advisor