Question
i pulled a muscle in my bicep region 8 wks. ago. the swelling went down. i now have a not located on th outer bi-cep head. it is located down toward the elbow portion of my bi-cep. should i be concerned that it is more then a normal tear, or should i get it looke dat for something more serious. thank you, mrlvin inscoe

Answer
Dear Mr. Inscoe,
Concerning your knot-there are a few things that could be happening.  

It is possible that you have a full thickness tear of one head of the bicep. Amazingly enough a full thickness tear is not that painful, and since the bicep is not the only muscle that flexes the arm, you may only have a minor loss of strength if any.

Normally if you have a complete rupture of a bicep head, the bulge that results from the trauma is located higher up on the arm from the muscle contracting.  Tears normally occur on the lower part (distal) of the muscle, not the higher part (proximal)... therefore the muscle contracts away from the site of injury and is located on the upper arm, not near the elbow.

The best way to properly evaluate the issue is with a thorough examination as well as an M.R.I. to visualize the area. If this is a major tear, you may have a lasting effect unless surgery can repair the damage.  Unfortunately, most of the surgeons I know would have wanted you in surgery within the first 7 days post injury, so you may not be a candidate for repair.

If this is truley a knot in the muscle, it is most likely a combination of an excess of fibrous scarring from the bodies nomal repair processes, as well as residual muscle spasm.  This can be handled very effectively with ultrasound, stretching and cross friction massage of the muscle.  A.R.T. (active release technique) is also a great option to help with resolution.  If this is the case, chiropractic treatment is a viable and prefered option of care.  You may also need bicep specific physical rehabilitation depending on the extent of injury.

Bottom line is you should get this evaluated further to properly determine the extent of remaining injury, dysfunction etc... this is the only way to initiate the proper course of action for resolution or management. A sports medicine trained orthopedic medical physician or sports medicine trained orthopedic chiropractic physician will have the appropriate education to evalute your condition the most effectively.

Respectfully,
Dr. J. Shawn Leatherman