Biceps brachii tendon tear

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Bicep Brachii Tendon

fanubrium of sternum

Pectineus

1st ribx Clavicle Coracoid process s Head of humerus v Acromion Lesser tubercle Greater tubercle.

Biceps brachii

Short head Long headx/

Xiphoid process Biceps brachii

Costal cartilage Brachialis

Linea alba

Biceps brachii, distal tendon, sectioned

Zygomaticus minor Zygomatics major Masseter Orbicularis oris Depressor labli inferioris Sternohyoid Sternocleidomastoid Trapezius Omohyoid Deltoid

Pectoralis major Serratus anterior Triceps brachii Latissimus dorsi Biceps brachii External oblique Brachialis ial epicondyle

Os coxa

Anterior superior Iliac spine

Ulna-Radius 5th lumbar vertebra''/

Sacrum Neck of femur Greater trochanter-Carpal 2nd metacarpal Proximal phalanx Middle phalanx Distal phalanx Pubic symphysis Diaphysls of femur

Gracilis

Adductor longus

Biceps brachii, tendon

Pronator teres

Extensor carpi radialis longus

Biceps brachii. aponeurotic expansion

Brachloradialis

Flexor carpi radialis

Palmaris longus

Flexor carpi ulnaris

Flexor digltorum superficialis

.Rectus abdominis, under the aponeurosis

Iliopsoas

Tensor fascia lata Pyramidalis Sartorius

Quadriceps

Tearing the long head of the biceps brachii is by far the most common serious sport-related biceps injury.

Generally, it occurs in a muscle, already weakened by tendinitis, after a sudden backward movement of the arm, e.g., during a throw. This movement is relatively common in baseball, tennis, and any sport involving a throwing action, but it also occurs in the snatch in weightlifting. During this motion, tension is suddenly placed on the long head of the biceps brachii, most often where Its tendon passes through the bicipital groove of the humerus.

Weightlifting, specifically the deadllft, with heavy weights can cause another characteristic biceps brachii injury.

A common practice when using heavy weights in the deadlift that prevents the bar from rolling In the hands is to use a reverse grip (one overhand grip and one underhand grip).

This technique, although usually safe, can in rare Instances cause the tearing or the pulling away of the Inferior tendon of the biceps brachii where the muscle inserts onto the humerus.

During the positive phase of the deadllft, the effort is mainly exerted by the muscles of the legs and gluteal muscles, the back, and the abdominal muscles.

The arms hang down, completely extended and relaxed.

Unfortunately, the slight shortening caused by contracting either head of the biceps brings the hand Into supination (the biceps being the strongest supinator), which with extra heavy weights may cause complete rupture of the tendon at the radius.

This Injury occurs at the distal attachment because as the arms hang next to the body, the proximal tension is divided between the short and long heads of the biceps brachii whereas, dlstally, only one tendinous insertion supports the tension. Compared to other tendon tears such as the pectoralls major or the adductors of the thigh In which the pain is unbearable and stops the athlete from continuing, the pain of a biceps tendon tear Is relatively mild despite the seriousness of the actual Injury,

In competitive power lifting, athletes have continued their lift despite the biceps tendon tear Incurred during that lift.

After the accident the diagnosis is obvious: swelling caused by hemorrhaging appears In the forearm. But what Is most striking is the appearance of the biceps brachii, which becomes ball shaped at the upper arm close to pectoralis major and the deltoid, revealing the brachlalls muscle lower down. Despite the tear, the brachlalis, brachloradialis, extensor carpi radialls longus and brevls, and pronator teres muscles can still flex the arm, just not as strongly. Supination of the forearm becomes much more of a problem because the end range of this movement relies only on the supinator muscle. If this injury is not immediately treated with surgery to reattach the biceps tendon onto the radius, irreversible retraction of the muscle will occur with fibrous change. And although moving the arm will still be possible, there will be permanent loss of strength In flexion and supination. It Is possible to prevent this Injury by regularly working the biceps, not to develop the muscle, but to strengthen Its tendon. For this reason add forearm flexion isolations using a bar In a series of "cheats" by leaning the chest back to give the bar a boost. If practiced regularly, this technique reinforces the distal tendon of the biceps by the tension It places on It. Nevertheless It must be performed carefully without rounding the back to avoid injury.

Pectoralls major

Deltoid

Biceps brachii, sectioned and retracted

Triceps brachii

Brachlalis

NORMAL BICEPS BRACHII MUSCLE

BICEPS BRACHII MUSCLE RETRACTED WITH TEARING OF ITS DISTAL TENDON

TYPICAL APPEARANCE OF AN UNTREATED DISTAL BICEPS TENDON TEAR

If, after tearing the distal tendon of the biceps brachii, surgery to reattach It to the radius is not performed quickly, permanent retraction and atrophy of the muscle will occur.

BICEPS TENDON ON THE ARM OF THE SUPINATED HAND CAN TEAR DURING A HEAVY DEADLIFT

TYPICAL APPEARANCE OF AN UNTREATED DISTAL BICEPS TENDON TEAR

If, after tearing the distal tendon of the biceps brachii, surgery to reattach It to the radius is not performed quickly, permanent retraction and atrophy of the muscle will occur.

NORMAL BICEPS BRACHII MUSCLE

BICEPS TENDON ON THE ARM OF THE SUPINATED HAND CAN TEAR DURING A HEAVY DEADLIFT

BICEPS BRACHII MUSCLE RETRACTED WITH TEARING OF ITS DISTAL TENDON

Pectoralls major

Deltoid

Biceps brachii, sectioned and retracted

Triceps brachii

Brachlalis

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