medical question?

[look 171]

I helped a friend remove an interior door. when he goes to put it back, he heard a pop in his elbow and it strarted to hurt. the ares felt hard areound the inside elbow. Tthat very same night, it swelled up. any ideas? the door was only about 25 lbs.

[Tobra]

torn biceps tendon maybe, tell him to ice it and go see a doctor, maybe wrap it up with a mildly compressive ACE bandage

[look 171]

if its torn, does he have to get cut open?

[Noah930]

Sounds like a torn distal biceps tendon, like Tobra said. Typically happens in men in their 40s and 50s. Sudden load of stress on the arm, like catching a tripping person or falling 55-gallon drum filled with liquid. There'll often be a pop, followed by pain in the antecubital fossa (the part of the elbow opposite the pointy part where you "elbow" someone). There might also be some pain, swelling, and bruising on the inside of the elbow (the side that brushes up against your ribcage).

It doesn't have to be fixed (which is done surgically). The biceps' major function is not elbow flexion, like we commonly think; rather, it's the major muscle responsible for supination: turning your palm upwards. So if it hurts your buddy to turn a screwdriver, that's suggestive of a distal biceps tear. People still have a surprising amount of strength to flexing/curling the elbow, even after a biceps tear. Most people seem to want to get the tendon repaired.

There's a bit of a difference (academically, at least) between a complete tear and a partial tear. You might or might not be able to feel the biceps tendon in that antecubital fossa, even if it's torn. Usually an MRI is done to confirm the diagnosis.

Surgery is best done within the first 2 or 3 weeks. It gets technically more difficult if you wait longer than that. The muscle may cause the tendon to retract, and if the muscle gets "used" to being in a shortened state, it might be difficult to stretch it back out to length at time of (delayed) surgery. That might necessitate the use of a tendon graft to bridge that gap between tendon and bone. (The tendon almost always snaps off at or right next to its insertion into the radius in the forearm.) Use of a tendon graft obviously ups the degree of difficulty of the surgery a little.

There are a couple different ways to do the surgery. But this can only be repaired surgically. At the same time, not everyone has to get it repaired. But most people who tear their distal biceps are middle-aged men. So they'd like to continue with their active lifestyles.

Recovery is a pain. After surgery, the regimen I dictate for patients takes 18 weeks (4 months). 6 weeks for range of motion alone (NO lifting). 6 weeks for gentle strengthening (1-5 lbs). 6 weeks for getting back to full strength.

[sammyg2]

Originally Posted by Noah930

Sounds like a torn distal biceps tendon, like Tobra said. Typically happens in men in their 40s and 50s. Sudden load of stress on the arm, like catching a tripping person or falling 55-gallon drum filled with liquid. There'll often be a pop, followed by pain in the antecubital fossa (the part of the elbow opposite the pointy part where you "elbow" someone). There might also be some pain, swelling, and bruising on the inside of the elbow (the side that brushes up against your ribcage).

It doesn't have to be fixed (which is done surgically). The biceps' major function is not elbow flexion, like we commonly think; rather, it's the major muscle responsible for supination: turning your palm upwards. So if it hurts your buddy to turn a screwdriver, that's suggestive of a distal biceps tear. People still have a surprising amount of strength to flexing/curling the elbow, even after a biceps tear. Most people seem to want to get the tendon repaired.

There's a bit of a difference (academically, at least) between a complete tear and a partial tear. You might or might not be able to feel the biceps tendon in that antecubital fossa, even if it's torn. Usually an MRI is done to confirm the diagnosis.

Surgery is best done within the first 2 or 3 weeks. It gets technically more difficult if you wait longer than that. The muscle may cause the tendon to retract, and if the muscle gets "used" to being in a shortened state, it might be difficult to stretch it back out to length at time of (delayed) surgery. That might necessitate the use of a tendon graft to bridge that gap between tendon and bone. (The tendon almost always snaps off at or right next to its insertion into the radius in the forearm.) Use of a tendon graft obviously ups the degree of difficulty of the surgery a little.

There are a couple different ways to do the surgery. But this can only be repaired surgically. At the same time, not everyone has to get it repaired. But most people who tear their distal biceps are middle-aged men. So they'd like to continue with their active lifestyles.

Recovery is a pain. After surgery, the regimen I dictate for patients takes 18 weeks (4 months). 6 weeks for range of motion alone (NO lifting). 6 weeks for gentle strengthening (1-5 lbs). 6 weeks for getting back to full strength.

I was gonna say that but ya beat me to it

[9dreizig]

The good news is Noah is willing to trade surgery for the replacing the boots on his CV joints!!!

[look 171]

Noah, are you thinking that surgery is not necessary? Will it heal itself? He's company closed its doors and left so he has no insurance. He's young, at 26, and didn't think anything could go wrong.

Jeff

[Noah930]

Well, I think it's worthwhile to make the right diagnosis, first. Better to see a physician (preferably an orthopedist). Physical exam is still worth a lot, despite all our fancy tests. An MRI might or might not be needed. But if he's truly got a distal biceps rupture and he's 26 years-old, I think most guys with those two criteria are going to go on to want surgery.

In the end, your buddy's dealing with pain and strength. If he has no pain and has adequate strength to his arm, surgery's not needed. But we don't have that crystal ball to see how he is several months from now. And surgery is a lot easier to do within the first couple weeks than it is down the line.

edit: CV joints/boots got replaced, today, with the help of slodave. Thanks, slodave.

[slodave]

Hmm, maybe I can share my thoughts...

I tore all the ligaments in my right shoulder about 4 years ago. My collar bone and shoulder bone are no longer connected. Due to the degree of the injury, surgery was elective. Today, my right arm hangs about half an inch lower than my left. Day to day, it does not bother me, but there are certain positions and activities - such as CV joint replacement and other under car work, that take their toll and I have to take frequent breaks. Those two bones are also now rubbing against each other, leading to issues later in life...

So, I read that he is young and he does not have ins., but I would at least recommend (stress) that he consult an orthopedist like Noah930 suggested. Your friend should know what exactly is wrong and the suggested treatments.

[look 171]

Noah, any idea what something like that cost. I might want to help him with some of the medical bills. His mother used to to be my house keeper when my we had our first kid until she found out she has cancer.

[Noah930]

Office consultation would run $250-$350.

MRI might be $1000-2000. There's also a radiologist's reading fee. Probably a couple hundred dollars at most (total guess).

Surgery would be several thousand dollars. See some of the other recent medical threads for Pelicans' medical pricing adventures. You'll have a surgeon's fee ($1000-2000), anesthesiologist's fee (probably more than the surgeon's), and facility/OR fee (wide range of possibilities--from a few thousand on up to over $10K, depending on the facility). Also probably a lab fee for the pre-op bloodwork; may be a another few hundred dollars.

All of these are rough estimates. Medical billing--particularly in the world of self-pay (non-insured) patients--is a bit of a wild wild west mentality. Billing will vary enormously. Self-pay patients are usually considered "no-pay" patients, as most people who don't have the means/forethought to get and maintain health insurance usually don't have the means to pay medical bills, either. So while self-pay patients get billed full price, you can often negotiate lower fees. You just have to do so with each individual entity (surgeon, anesthesiologist, lab, MRI center, OR, etc.).

Oh, and he'll need post-op rehab, too. Surgeon's fee covers all care (by the surgeon) for 90 days following the procedure.

[look 171]

From your other post, it sound like he might not need surgery? will it heal itself? Thanks Noah 930. If I could return a favor, feel free to ask. When you find that dream home, I can help you look at it and tell you if it good or not. I am a contractor in LA. You go out and play with the boys up in Mullholland, so you must be from this area. If not we could talk 930 sometimes.

[Noah930]

Thanks for the offer.

No one NEEDS to have their biceps tendon repaired. (And, remember, that's just your friend's internet diagnosis--not necessarily what he actually has. It's not common for this injury to strike a young guy, like your friend. Most of the time it's guys in their 40s or 50s.) But, in general, young active guys will probably want to have the surgery done. Heck, most guys in their 40s and 50s want to have this surgery done.

Again, we're dealing with pain and (lack of) strength. The pain will subside remarkably over the next couple weeks. But he might be left with some residual pain whenever using the hand/arm for strenuous activity. That's probably unacceptable in a 26 year-old.

Strength will also be limited. Partly due to the pain (which will improve --> and so will the strength), and partly due to the impaired muscle/tendon function. Flexing the elbow will probably not suffer much, if at all. The biceps doesn't really contribute that much to elbow flexion strength, surprisingly. But forearm supination (turning your palm upwards) is primarily done by the biceps (as well as a couple other, smaller muscles). So your friend may notice some future difficulty in turning a doorknob or screwdriver or key. Again, something most 26 year-olds are not going to like.

[Ray B]

I'm 1 month post-op for this surgery. Agree w/ all above. Thanks Noah. It IS a PITA. The cost is very high by the time you see everyone you must for proper diagnosis and treatment. As others have noted-sooner is better for a better chance of a full recovery. There can also be complications w/ the surgery. I have a neuropraxia ( nerve "pressure") which does not allow me to extend my fingers. It is very frustrating not knowing if/when motor function will return. Most folks recover fully and have most/all of their range and strength return in a few months-so I'm told. I'm 50 yrs old and very active so the decision to have the surgery was an easy one. Recovery is the hard part thus far. Good luck to your bud.

[Noah930]

Ray, if you can't extend your fingers after this surgery, most likely it's due to something going on with the PIN (Posterior Interosseous Nerve). It's a branch of the radial nerve, and it controls the muscles that, well, extend the wrist and fingers. The nerve may or may not recover, as you've been told. It may take weeks to months for it to recover, too.

In the meantime, make sure you are passively extending those digits (use your other hand to extend and even hyperextend them). You don't want the ligaments and joints to get stiff and then be stuck in that flexed position, even after the PIN recovers. Your therapist should also be able to make a thermoplastic wrist splint to help keep those fingers "up."

[craigster59]

I had this happen to my left bicep while installing siding on my garage. Lifting the tailend of a warped board to nail in place and "pow". Had a good surgeon, incision in the bicep area and back of forearm, pull the muscle down and attach with suture to small pins in the bone. Everything is fine now although I no longer wear a watch on my left hand (can't turn it far enough to see the dial)

[rattlsnak]

Originally Posted by Ray B

I'm 1 month post-op for this surgery. Agree w/ all above. Thanks Noah. It IS a PITA. The cost is very high by the time you see everyone you must for proper diagnosis and treatment. As others have noted-sooner is better for a better chance of a full recovery. There can also be complications w/ the surgery. I have a neuropraxia ( nerve "pressure") which does not allow me to extend my fingers. It is very frustrating not knowing if/when motor function will return. Most folks recover fully and have most/all of their range and strength return in a few months-so I'm told. I'm 50 yrs old and very active so the decision to have the surgery was an easy one. Recovery is the hard part thus far. Good luck to your bud.

thats what happens when you don't switch hands occasionally...

[Ray B]

Thanks Noah. That's exactlt what I've been told. I have a splint to keep my hand extended. I'm keeping my fingers crossed that I'm in the majority who recover function.

Rabbitsnatch, Thank you too for your input. Always insightful. I'd be a fool not to heed your professional expertise.