Joe A Shaw PA-C - 3/14/2008

Question
Recently I had an intense pain in my armpit for no apparent reason, the next morning I woke to find a large bruise on the inside of my bicep(left) which eventually spread all the way to my wrist along with swelling of the arm, pec, and underarm area on that same left side. My Doctor ordered x-rays which were negative and then an MRI which showed a complete tear of the short head bicep tendon. I am told this is very unusual(short head as opposed to long head)and in fact I saw one website say that bicep ruptures only happen on the long head side.I was referred to an orthopedist who said I should do nothing except put heat on it and rest it while the tendon scars over. I don't have much faith in this course of action and can find no info on short head rupture treatments. I got the impresession he was guessing and in fact he didn't even look at the mri and barely  examined my arm. From what I have read when a long head tendon tears it may be appropriate to let the injury heal without surgery, is this true for a short head tear as well? What do you know about this type of injury? What are my treatment options? If I later decide to have surgery is it possible once the tendon has "scarred" over or is it to late at that point?12-days after the injury I have some swelling still and pain running down the length of my arm that feels sort of like I whacked my funny bone, and I wake  frequently during the night with waves of pain that subside and then return over and over.
thanks,
43y/o male


Answer
matt,
What is bizzare to me is that you just woke up with it? I have never heard of that...it takes a lot of force to tear a bicep!!!
I have referred several bicep tears to orthos...most are not repaired surgically unless it is a large or total rupture. Most were given conservative treatment..age > 40 yr and nonathlete are less likely to get a repair...in the end it almost never effects your ADL's activities of daily living. You may have seen this but I will attach it as it has good pics etc..
It never hurts to get a second opinion...one who does a lot of upper ext work or a sports med ortho.if your not sure about the first ortho. The swelling and bruising and pain does take a while to resolve weeks to months..the pain and range of motion should get better.You also want to ask about physical therapy.
http://www.orthogate.org/patient-education/elbow/distal-biceps-rupture.html


F/U I never have been told by ortho's of pts I referred to them whether they had a short head rupture vs long head.