Injuries and Medical Advice

Blown Biceps

Q:

While desperately manteling a highball 10 years back (I am now 46), I felt my shoulder shift and heard alarming noises. Although I recovered, my shoulder has recently become painful. I had an MRI and saw a surgeon. I damaged the labrum and the bicep, which is cutting through the subscapularis tendon. The surgeon wanted to cut the bicep tendon free at the shoulder and leave it. I have heard it is normal procedure to reattach it. When I saw him a second time and asked about this, he said, “I’m not going into detail until you’ve studied six years of medicine.” I called him a bad name and left. What do you think?

A:

Good on you. Once upon a time doctors, in particular specialists, got away with an expedient “This is very complex and beyond your tiny mind” attitude. Nonsense.

Yours was a very pertinent question and one easily answered. See a more socially adept and communicative practitioner, one that you like and trust. Perhaps Google “stable genius surgeon” and see who you find.

At the top of the arm the bicep tendon runs in a short groove. A small ligament bridging the groove locks the tendon in place. In your case, this ligament has ruptured, and the dislocated tendon is abrading the subscapularis tendon. Imagine a rope running across another rope. The surgeon needs to repair labral damage, stop further delamination of the subscapularis tendon, and release the bicep tendon.

The topic of tenotomy (cutting the tendon) versus a tenodesis (reattachment farther down the shaft of the humorus) is a contentious one among surgeons. Peer reviewed data indicates that there is little difference in terms of functional outcome —strength, coordination, range of motion—but it is difficult to compare individual studies due to the methodology variables between them, namely surgical techniques. In the instance of a tenotomy, the muscle, once released from the shoulder, bunches above the elbow creating a “Popeye” look. I use several shoulder specialists and they have always opted for a tenodesis.


Q:

I am 50 and have climbed for 30 years. Last year while bouldering I completely ruptured the distal bicep tendon in my left arm. I had the tendon surgically reattached and was climbing six months later and seemed to have made a full recovery after a year. However, I wince every time I grab an undercling. My surgeon said that I wouldn’t have any lingering issues and that I could climb, but I don’t know if he understood the forces that climbing puts on our bodies. So, will I be fine? Is there a scar-tissue time bomb just waiting to go off at the attachment point, or do I have a bionic bicep complete with screws? Should I retire or just lose weight? I hope I don’t have to take up golf. I would never look good in those pants.

–Scott Bouldien, Indianapolis, IN

A:

Rupture of the distal bicep tendon, such that it recoils up the inside of your arm toward your shoulder, is not exactly common, afflicting about 1.2 persons per 100,000 each year. It affects mostly men over 30 years of age doing something strenuous, and I dare say that the rate of incidence is somewhat higher if you looked at the climber cohort.

Surgical intervention within a week or so of the injury is the only option if you want full function and strength. A few weeks of “It’ll be fine” will categorically change your options and prognosis. By the time the mounting evidence of pain and dysfunction debunk the entrenched denial, reattachment has become far more complicated, if not prohibitive.

The distal insertion has two attachment points: one to the radius and the other forming a fascial, or soft tissue, attachment just under the skin. All hell breaks loose with a full rupture—popping noises, pain and a bicep that bunches in your arm as it recoils toward your shoulder (called “Popeye Sign” for reasons that do not need explanation).

A year down the track and a whole bunch of rehab (read: climbing) has obviously done you well, i.e., it hasn’t broken again. The issue that is causing you to wince is unlikely to end in another cataclysmic moment. If the tendon has tolerated load for the last six months, any concern about another rupture is probably unfounded.

Turning your hand into a palm-up position while your elbow is flexed, as it is when you undercling, is the primary role of your bicep. Something is getting pinched/tweaked/ stretched in your elbow, but it is unlikely to relate to the integrity of the attachment itself. The pain is simply feeding your anxiety that it might! For example, I broke my ankle snowboarding 10 years ago and it can give me some trouble at times, but that doesn’t mean the fracture is in some way still weak or prone to breaking again.

To address some of your other questions: (1) No, you do not have a bionic arm. Only I have bionic arms. They are amazing. You should see them. Hottie says they haven’t changed in 20 years; bless her cotton socks. (2) Retirement is for the half-hearted. (3) If you’re fat, then lose weight—I have never met anyone who regretted it. (4) Golfing attire has a time and a place—I keep a pair of lovely tartan pants just next to my backless chaps.


These articles appeared in Rock and Ice 249 and 241


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