Quote:
Originally Posted by Shaun @ Tru6
(Post 12328082)
Thanks for the well wishes everyone. Went to the doctor this morning and based on the swelling, bruising and range of motion against pain, the nurse practitioner thought it may be ruptured. She tried to schedule and ultrasound to confirm today but I never got a call.
Oddly enough, it's felt pretty good today using it for sanding and shooting some Cerakote. So maybe a miracle is in the works.
Dan, I hope your fix goes well, left hand or not, I think we take health a little too much for granted, at least I do.
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Often, it's an MRI that gets done to rule out a distal biceps tendon tear, though an ultrasound can work as well. But if there's no biceps tendon palpable in the antecubital fossa and there was a lot of pain and bruising initially, then most likely the distal biceps ruptured. Though sometimes people can confuse the lacertus fibrosis for an intact distal biceps tendon. Does your right bicep muscle look any different than the left side? People with a distal biceps tendon rupture sometimes get a Popeye deformity of the upper arm as the biceps muscle scrunches up.
How long ago was the original injury? Ideally, if you have surgery, make the utmost effort to get it done within 3 weeks. After 3 weeks, if you have a complete rupture with proximal retraction of the biceps tendon, the biceps muscle may become accustomed to a shortened length. Then, at time of surgery, it may be difficult to pull the biceps back out to length, necessitating an interpositional tendon graft (to act as a bridge between the tendon and the bone). I usually use a cadaveric Achilles tendon for that (I always ask that one be ordered and available if necessary), but there are other options possible (like using your own tensor fascia lata or palmaris longus tendon). I've never had to use an interpositional graft with a surgery less than 3 weeks. I usually don't need one even on a surgery more than 3 weeks out from injury, but the few times I've used a tendon graft, it was always for a delayed injury.
There are about 3 or 4 main ways to reattach the tendon. The engineer in you will geek out at the theory behind each of them. But all methods are stronger (tensile strength) than the original bone-tendon junction.
Recovery is usually pretty complete. The expectation is that you can do everything again. But recovery will take 4 months. First 6 weeks, you just work on range of motion--no weight at all. 2nd 6 weeks is light strengthening: 1-5 pounds. 3rd 6 weeks is strengthening back up to normal. It's a long slog. Good luck.
Interestingly, you mention that pain may actually be subsiding. The traditional thinking is to operate on everyone who has a distal biceps tendon rupture. I was chatting with Milan Stevanovich, the professor from USC. He mentioned that they once followed a cohort of patients who never had surgery. (It's USC--there are a myriad of ways patients don't get proper/timely care or get lost in the system at a place like that.) Surprisingly, most of them did pretty well. He tried to write a paper, but it never got accepted anywhere--he thought because there's no glamour or money to be made in not doing surgery.
The biceps tendon's main function isn't flexing the elbow (there are other muscles that can do that, too), but rather supinating the forearm (turning your palm upwards), such as in turning a screwdriver or doorknob. So if you can still lift and turn screwdrivers (and not have pain) despite a ruptured distal biceps tendon, then maybe surgery isn't necessary.
