Understanding a biceps injury

In the Chicago Bears’ loss to Seattle a few weeks ago, they also lost their veteran defensive tackle, Will Sutton near the end of the first half with what the team describes as a biceps injury to his left arm. The long head of biceps muscle runs across your shoulder and elbow along the front of the humerus (upper arm bone) and is connected by a tendon to the top of the glenoid bone (shoulder socket) in the shoulder joint and to the radius (forearm) bone below the elbow. The tendons help bend your elbow and rotate your forearm. They also may play a role in shoulder function. Most sports related biceps injuries result from overuse and repetitive motion; however, the biceps tendons can rupture as the result of an injury.

Biceps injuries are differentiated by the injury location either to the muscle/tendon junction or to the tendon near the attachment point. The injury may be either proximal (near the shoulder), or distal (near the elbow). Biceps tendinitis and tenosynovitis occur both proximal and distal and are characterized by pain and inflammation usually from overuse and usually in sports such as baseball, swimming, tennis and golf. Although painful, the conditions can be treated conservatively. Generally, strains or injuries at muscle/tendon junction also are treated conservatively. Treatment consists of rest, ice, anti-inflammatory medication and therapeutic exercises. Time on the bench varies. Generally, athletes can return to play as pain and symptoms allow.

Complete ruptures of either the proximal or distal biceps tendon can occur from extreme force being applied to the arm, typically while eccentric contraction of the biceps is trying to resist that force. Athletes participating in heavy weightlifting or contact sports can sustain a complete rupture. The use of anabolic steroids also increases the risk for ruptures to the muscle tendons. When this injury occurs distally near the elbow, the biceps tendon ruptures off the bone allowing the biceps muscle to retract up the arm like a window shade. When the injury occurs proximally near the shoulder, it retracts down the arm. Surgery usually is required for distal ruptures within three weeks of the injury to be able to reattach the tendon to the bone. If distal ruptures are not repaired, weakness, especially in forearm rotation (turning a screwdriver, doorknob, etc.) and painful cramping with heavy lifting will result. Proximal ruptures cause less disability and can be treated conservatively or surgically repaired. Surgical repair requires six weeks in a sling followed by four to six months of rigorous rehabilitation to regain strength and return to the game. Players can return within a shorter length of time if they opt for conservative treatment.

Because there has been no mention of surgery, Sutton most likely suffered a lesser biceps injury. Magnetic resonance imaging (MRI), used to view soft tissues inside the body probably was ordered to help determine the location and severity of Sutton’s injury. For Bear’s fans, a low grade biceps strain at the biceps muscle/tendon junction would be good news because he should be able to return in a couple of weeks to help the battered and bruised lineup.

More important, you do not have to be a 300-pound athlete to strain or rupture your biceps tendon. In fact, it is more common for older, more sedentary patients to injure their untrained tendon trying lift or carry a heavy object. Remember to warm up, stretch before tackling any heavy lifting tasks and always use good mechanics. A routine of moderate strengthening, stretching and general exercise to keep you in good physical condition and avoiding difficult lifting tasks can lessen your risk for a biceps injury.

For more information about sports, knee and shoulder injuries, visit my website, stevenchudikmd.com. To schedule an appointment at either my Westmont or Western Springs offices, please call 630-920-2350.

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