History and Physical Examination

A 72-year-old man presents to the emergency department (ED) complaining of elbow and biceps femoris tendon (biceps) pain. He states he was at home when he had a mechanical fall on the stairs and grabbed the handrail with his right arm while falling to the left. He describes pain, biceps weakness, and a lump on his muscle with a divot that is proximal to the antecubital fossa. He denies fever, near syncope, or other injury or complaints.

On examination, vital signs appear normal; however, elbow flexion and supination are weak.  Initial concerns include muscle tear, tendon rupture, and fracture. The patient underwent radiographic examination per his request but the radiographs appeared normal. Figures 1 and 2 depict images of the right arm and uninjured left arm, respectively.

What do the images show? What should your next step be?

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This article originally appeared on Clinical Advisor