Ruptured bicep

A month ago I tore a bicep loose at the distal end (at the elbow). I was doing housekeeping and picked up something with both hands that only was maybe 30 lbs but the hand on the involved arm was fully supinated (palm forward and thumb turned well outboard). I lifted and it tore.

https://www.hostpic.org/images/2012170341390103.png
^^^ Distal bicep rupture ^^^

The vast majority of bicep ruptures occur proximally, near the shoulder. Only about 3% occur distally. Lucky me.

With nothing anchoring it at the lower end, the muscle retracted about four inches up the arm and bunched up into a wad under my arm and near the armpit that was about the size of a baseball (which doctors refer to as "Popeye sign").

https://www.hostpic.org/images/2012170337500103.jpeg

So by the time I finished screaming and had a look at the bulge, I had figured out this wasn't going to fix itself. I walked to the deep freeze, pulled out an ice pack, applied it to the arm, got dressed and drove myself to the ER.

I was able to get to to see an orthopedic surgeon in just three days. He told me that a biceps repair could wait as long as a month but prognosis improved the sooner it's done, so I opted for surgery ASAP. There was a problem in that when he felt the drawn-up muscle he couldn't find "the stump," a remnant of the ligament at the far end of the bicep that was supposed to keep it attached to the (radius) bone in my forearm. Apparently surgical repair isn't possible if there's no 'stump' but my bicep was so severely retracted that he couldn't be sure there wasn't one so he sent me for an MRI on the following day, which was a Friday. The MRI showed a stump so on the following Monday he performed a single incision distal biceps surgical repair with Anthrex tension slide, exactly as shown in this video.

https://www.youtube.com/watch?v=Nhs5y_mtTps

The surgery went well and I left the hospital with my arm in a half-cast (they called it a 'splint') that went from just below my thumb up to about the middle of the upper arm, with my elbow bent at a right angle to minimize the stress on the repair.

The best part about the surgery was that the anesthesiologist gave me a hit of fentanyl and it was about a minute and a half (I watched the clock) before he followed up with the propofol (after which it was nitey-nite). But 90 seconds on fentanyl is like a month-long par-tay! The odd thing is there's no euphoria (like with opiates), it just feels like somebody poured 10 gallons of concentrated "I Don't Give a Fuck"-ness over your head. It is really a bizarre sensation.

The button is made from titanium, part of my growing collection of ortho appliances from Smith & Nephew. I should probably buy stock in the company.

I didn't have any post-op pain to speak of, but then I rarely do. Injury aside, most people probably could expect to have at least mild discomfort after having a hole bored through a bone in their arm but I have an extensive history of not hurting after surgery. And by "not hurting" I mean not even a little. For the first few days the biggest pain in the ass was trying to sleep with my arm permanently bent at a right angle and safeguarded with a sling.

The splint stayed on a little more than two weeks and then was swapped for a brace with an adjustable hinge at the elbow. Initially the hinge was adjusted to give me +/-20° of flex from the splint's 45° angle. I've always thought the hinged arm brace was the coolest-looking orthopedic appliance there was, like something Mad Max would wear. You've probably seen guys in NFL wearing the exact same contraption.

https://www.hostpic.org/images/2012170441210098.jpg

After not yet a week in the brace my arm is feeling pretty normal (considering the limited range of motion) except that my hand doesn't much like being supinated (rotated outboard, palm up), and I don't wonder. It actually feels so near normal that I'm sure that if it weren't for the brace limiting how much I can move it, I'd already have forgotten the injury -- at least momentarily -- and done something stupid to pull loose the repair.

The tabs on the brace that those velcro straps run across are adjustable but wearing it all day can be irritating so I wear a sleeve under it. Part of my bicycling clothing is sleeves with no shirt attached so you can wear them at the start of a cool ride but slide them off when it gets warm, and they were tailor-made for this. If you don't have any such, don't try to tough it out. Take my advice and cut the sleeve off an old sweatshirt and wear underneath it. Makes it much easier to sleep in.

I go back in a little more than a week to have the brace adjusted for an extra +/-20° of motion, and then the same again two weeks after that. How long the brace will have to stay on in total will depend on how well the surgeon thinks the healing is going. Full recovery will run at least six months and possibly as long as a year. And at this point I still can vividly remember the moment it tore, so I'm in no hurry.

The best part about the brace (compared to the splint) is that it's easily removable by design. So I can take it off to bathe, or just to scratch the hell out of my arm. And even with just 20° of motion I find I'm able to touch my face with that hand. Or wash the opposite armpit. Funny how you take little things like that for granted ... until they're gone.

I'll update this thread if anything significant happens.

Welcome to the club brother.

I’m about 9 idk maybe 10 months post op now. 34 years old, tore it dead lifting. I’ll give you the good, the bad, and the ugly. Well, just my opinions and theories lol some purely anecdotal and some from my PT. Fire away any questions!

Damn Beetle. Sorry to hear this. A few years back I was trying to move a floor safe, one of those 5' tall ones. Slipped my hand under an edge (supinated as you described) and it bit me. I looked down waiting to see it curled up and it wasn't. Ended up a partial distal tear thankfully. I can't imagine dealing with what you're doing right now.

Funny you mention propofol. I just had an endoscopy last week and they used it on me. He said I was going to go to sleep now and I asked him how long it would take. He said you tell me and I was out. Procedure only takes about 10 minutes (Have Barretts Syndrome) but when I woke up I felt like I had been in such a deep sleep that it was great. Told him to put me back out. I understand why Michael Jackson was hooked on it now.

And damn, that video is a bit scary and fascinating at the same time. No doubt the doc wrote you a script for GH and Var etc to help heal, right!..........

Glad you're doing well. Heal up and get back at it.

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Originally Posted by kelkel

Damn Beetle. Sorry to hear this. A few years back I was trying to move a floor safe, one of those 5' tall ones. Slipped my hand under an edge (supinated as you described) and it bit me. I looked down waiting to see it curled up and it wasn't. Ended up a partial distal tear thankfully. I can't imagine dealing with what you're doing right now.

Funny you mention propofol. I just had an endoscopy last week and they used it on me. He said I was going to go to sleep now and I asked him how long it would take. He said you tell me and I was out. Procedure only takes about 10 minutes (Have Barretts Syndrome) but when I woke up I felt like I had been in such a deep sleep that it was great. Told him to put me back out. I understand why Michael Jackson was hooked on it now.

And damn, that video is a bit scary and fascinating at the same time. No doubt the doc wrote you a script for GH and Var etc to help heal, right!..........

Glad you're doing well. Heal up and get back at it.

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I just went back and re-read his post! I was like hold tf, how did I overlook that this lucky Mfer and his doctor writing him a temp script for GH and var?! Lol

Quote:

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Originally Posted by kelkel

Damn Beetle. Sorry to hear this. A few years back I was trying to move a floor safe, one of those 5' tall ones. Slipped my hand under an edge (supinated as you described) and it bit me. I looked down waiting to see it curled up and it wasn't. Ended up a partial distal tear thankfully. I can't imagine dealing with what you're doing right now.

Funny you mention propofol. I just had an endoscopy last week and they used it on me. He said I was going to go to sleep now and I asked him how long it would take. He said you tell me and I was out. Procedure only takes about 10 minutes (Have Barretts Syndrome) but when I woke up I felt like I had been in such a deep sleep that it was great. Told him to put me back out. I understand why Michael Jackson was hooked on it now.

And damn, that video is a bit scary and fascinating at the same time. No doubt the doc wrote you a script for GH and Var etc to help heal, right!..........

Glad you're doing well. Heal up and get back at it.

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Fentanyl and propofol both get a lot of bad press these days but that combination is pretty much what America's surgery industry runs on. The effects come and go quickly, there's minimal depression of CV function, untoward side-effects are rare, and there's no post-op "hang-over." And depending on the length of the procedure, there's also a gas given for anesthesia "maintenance." This go-round I got Sevoflourane, which is a derivative of ether.

GH and Var? No, this was courtesy of the VA, so I was lucky they didn't give me a a leather strap to bite on during the surgery and send me home with a bottle of 80-proof Old Panther Breath for post-op pain.

Seriously, my VA facility is co-located with a major teaching hospital and the two facilities share staff. So their surgery department is very good. Really the only down-side (as opposed to going to a 'civilian' doctor) is that I have no choice regarding who's running the scalpel. At least I got to meet the guy beforehand and take the measure of him, then fold that impression into my decision whether to have the surgery.

And thanks for the well-wishes. It's a cakewalk from here ... right up until the next time I pick up a dumbbell to do some curls. :eek:

OT but a while back I got curious about what chemical they used when they dart an elephant. What the hell is so potent that you could fit enough into a hypodermic-sized dart that it would knock out a 12,000-lb pachyderm in a matter of (single digit) minutes? It turns out that one drug they use is carfentanyl, which, as you might guess, is a derivative of fentanyl. Carfentanyl is 100x more potent than fentanyl, which is 100x more potent than morphine. The fentanyl dose they give humans is measured in milligrams and there's 28,000 milligrams to an ounce. Das some powerful shit.

Makes you wonder why someone would look at something 100x more potent than morphine and ask, "I wonder if we could make this 100x stronger?"

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Originally Posted by Beetlegeuse

GH and Var? No, this was courtesy of the VA,

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Twas a bit of sarcasm on my part. But it would be nice wouldn't it!

I get to go in and have that done on Jan 17 and re attaching the rotator cuff tendon. Whatever you do DONT do any lifting until the doc says it's healed. Im sure I probably lifted something within the first couple of weeks that made mine detach. Never felt it but I guess it was obvious when he saw it. Damn and I was hoping I had retained some muscle mass. lol

Good luck Beetle, glad it was distal.

I had a follow-up visit earlier this week, about five weeks post-op. I had been in the hinged brace for two weeks with the elbow articulation limited to +/-20° and was expecting that to double to +/-40° on this visit but instead the doc pulled out all the stops. Now I only have to wear the brace when I go out (sort of a "keep of the grass" sign) or go to bed. The rehab focus has shifted to regaining range of motion (in the wrist and elbow) and beginning to strengthen the bicep itself.

Besides the flexing stuff I'm supposed to do 2-lb curls for two weeks, then go up to 4-lbs. Yeah, I do happen to have 2-lb dumbbells from my many supraspinatus repair rehabs.

When the splint first came off I had a pretty misshapen arm about the elbow, as if my "Popeye sign" had slid down from near my arm pit all the way to the elbow. And my forearm was slightly swollen all the way to the wrist, but that's all gone now and it looks like a 'normal' arm, albeit very skinny and with a fresh 3" scar in the crook of my elbow.

After just a few days I've already got full ROM in my wrist but it will be a while yet before I can fully straighten the elbow. And I'm telling ya, them 2-lb curls are flat wearing me out.

Doc was pleased with my progress and I'm happy with the result as well. But I'm still anxious about (eventually) going back to my regular resistance training routine because the weight I was lifting with both arms when my bicep blew was about the same as what I usually do dumbell curls with (oand obviously with just a single arm).



Something I failed to mention earlier that my surgeon told me on my initial office visit. He said that two factors that have been identified in increasing the incidence of bicep rupture are smoking cigarettes and taking steroids.

I tried to pin him down, asking if this included just TRT-sized steroid doses or if it was limited ti Arnold Schwartzawhoozit-sized doses. And his answer was one word, "Steroids."

I found a white paper on it since then and that's all the info it gave, too. They don't appear to discriminate between old codgers doing 50mg a week or young turks doing 500 mg e3.5d.

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Originally Posted by Beetlegeuse

I found a white paper on it since then and that's all the info it gave, too. They don't appear to discriminate between old codgers doing 50mg a week or young turks doing 500 mg e3.5d.

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Of course not. Steroids are just bad.

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Originally Posted by kelkel

Of course not. Steroids are just bad.

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Well, ... if I'm honest, for some people they are bad.

https://www.hostpic.org/images/2101080320230109.png

Berry, berry bad.

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Originally Posted by Beetlegeuse

I had a follow-up visit earlier this week, about five weeks post-op. I had been in the hinged brace for two weeks with the elbow articulation limited to +/-20° and was expecting that to double to +/-40° on this visit but instead the doc pulled out all the stops. Now I only have to wear the brace when I go out (sort of a "keep of the grass" sign) or go to bed. The rehab focus has shifted to regaining range of motion (in the wrist and elbow) and beginning to strengthen the bicep itself.

Besides the flexing stuff I'm supposed to do 2-lb curls for two weeks, then go up to 4-lbs. Yeah, I do happen to have 2-lb dumbbells from my many supraspinatus repair rehabs.

When the splint first came off I had a pretty misshapen arm about the elbow, as if my "Popeye sign" had slid down from near my arm pit all the way to the elbow. And my forearm was slightly swollen all the way to the wrist, but that's all gone now and it looks like a 'normal' arm, albeit very skinny and with a fresh 3" scar in the crook of my elbow.

After just a few days I've already got full ROM in my wrist but it will be a while yet before I can fully straighten the elbow. And I'm telling ya, them 2-lb curls are flat wearing me out.

Doc was pleased with my progress and I'm happy with the result as well. But I'm still anxious about (eventually) going back to my regular resistance training routine because the weight I was lifting with both arms when my bicep blew was about the same as what I usually do dumbell curls with (oand obviously with just a single arm).



Something I failed to mention earlier that my surgeon told me on my initial office visit. He said that two factors that have been identified in increasing the incidence of bicep rupture are smoking cigarettes and taking steroids.

I tried to pin him down, asking if this included just TRT-sized steroid doses or if it was limited ti Arnold Schwartzawhoozit-sized doses. And his answer was one word, "Steroids."

I found a white paper on it since then and that's all the info it gave, too. They don't appear to discriminate between old codgers doing 50mg a week or young turks doing 500 mg e3.5d.

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Corticosteroids are a steroid and yes, they can be bad for tendons.

Quote:

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Originally Posted by Beetlegeuse

I tried to pin him down, asking if this included just TRT-sized steroid doses or if it was limited ti Arnold Schwartzawhoozit-sized doses. And his answer was one word, "Steroids."

I found a white paper on it since then and that's all the info it gave, too. They don't appear to discriminate between old codgers doing 50mg a week or young turks doing 500 mg e3.5d.

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I’d have fucked with him and brought up the fact that Vitamin D is a steroid as well. Never mind the fact that women ramp up their endogenous nandrolone production when pregnant, as nature’s answer to the problem with testosterone’s masculinizing effects.
That said, almost no doctors understand the biological context of these correlates anymore. They just vomit forth the basics of what they learned in med school (and basics for AAS is being generous for what they’re taught) and call it a day.

Gallowmere, I've lost actual count but I've had 12 or 15 orthopedic procedures in my life, mostly the foreseeable consequence of a too-adventurous-by-half youth. Then there was a long lull but now that I'm eligible for the Senior Citizens Discount, the pace has picked back up. Father Time seems hell-bent on convincing me I'm too old for this shit, whatever shit it is that I happen to be into at the time. So I am disinclined to fuck with my orthopedic surgeon until I'm fair certain I'll have no further need of his services. And as of this moment I hope -- Insh'Allah -- to keep him in business a while yet.

Curious as to the aesthetic look of your arm now? Obv aside from the atrophy, but is the “gap” (separation in the area of the tear) still visible?

Atrophy is about it, at least at the moment.

The surgical notes mentioned the doctor had split the fascia at one point in the procedure (without bothering to mention where or how much), and if you've ever had (or seen the results of) a fasciotomy you know that they usually leave the muscle 'misshapen' because the fascia is what confines the muscle group and gives it its characteristic shape. I'd had one fasciotomy previously and that muscle looks nothing like its counterpart on the opposite side of my body.

However, at this point I'm surprised by bicep has retained as much muscle tone as it has, and if it's going to be shaped much differently from before the tear, I'm not yet seeing it.

I guess I should’ve done more research on different techniques.. my surgery was the “endobutton” repair, where the distal tendon is reattached towards the inside of the forearm/elbow. The surgeon was referred. He works with TCU athletes so there was no fear of lack of expertise. Granted, it hasn’t been a year since surgery, and idk maybe 6 months of lifting again. Obv the entire arm (bicep, tricep, forearm) isn’t back to the size it was.. BUT, there is still a slight gap. Maybe I’m just overly vain as I was hoping for it to look more like it did pre tear.

I don't know that I won't be that way. My pecs are mismatched because I've broken both collar bones multiple times. Each time they healed the bone was a little more bent than before, which meant the "architecture" of my shoulders changed. Which is why I tell everyone who'll listen who gets a broken clavicle to INSIST that it be pinned back into the original shape. Doctors as a rule don't want to break the skin on a closed fracture if they can help it, but it's not them who has to spend the rest of their life walking around with a lopsided chest.

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Originally Posted by Beetlegeuse

I don't know that I won't be that way. My pecs are mismatched because I've broken both collar bones multiple times. Each time they healed the bone was a little more bent than before, which meant the "architecture" of my shoulders changed. Which is why I tell everyone who'll listen who gets a broken clavicle to INSIST that it be pinned back into the original shape. Doctors as a rule don't want to break the skin on a closed fracture if they can help it, but it's not them who has to spend the rest of their life walking around with a lopsided chest.

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How on earth did you break them multiple times? Damn

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Originally Posted by kelkel

How on earth did you break them multiple times? Damn

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I faw down go boom.


It was several different mishaps, only one of which resulted in more than a single fracture. Some happened while I was doing army shit and some while I was learning that I had athletic ambitions I didn't have the talent to support.

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Originally Posted by Beetlegeuse

I faw down go boom.


It was several different mishaps, only one of which resulted in more than a single fracture. Some happened while I was doing army shit and some while I was learning that I had athletic ambitions I didn't have the talent to support.

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Ok, that was quite funny.

Jus' bein' onyx. Truth be told, some of that was because I had more balls than brains.

I've always figured the only way to know what your limits are is to exceed them. Then wait to see what happens next. In contrast to the advice offered by one of my ex-wives, who delighted in telling me, "Do stupid shit, pay stupid taxes."


When I was a kid, I figured out pretty quick not to touch the burner on the stove when it was glowing red hot.

My problem was, that stove had three more burners.

Quote:

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Originally Posted by Beetlegeuse

Atrophy is about it, at least at the moment.

The surgical notes mentioned the doctor had split the fascia at one point in the procedure (without bothering to mention where or how much), and if you've ever had (or seen the results of) a fasciotomy you know that they usually leave the muscle 'misshapen' because the fascia is what confines the muscle group and gives it its characteristic shape. I'd had one fasciotomy previously and that muscle looks nothing like its counterpart on the opposite side of my body.

However, at this point I'm surprised by bicep has retained as much muscle tone as it has, and if it's going to be shaped much differently from before the tear, I'm not yet seeing it.

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If the bicep retracted much, it’s likely the reason.

I tore my left bicep tendon about 20 years ago. Playin golf of course. I was lifting pretty good back then, but swinging a club is what finally did it. Felt a sharp pain like someone stabbing my bicep with a knife while teeing off. It passed, so I decided to go on and the next hole tee'd off again and pain was worse, so I stopped playing. Got the popeye look immediately, so I knew it was a completely ruptured head tendon, or would shortly when diagnosed

DR checked me a couple days later and said I didnt seem to lose much strength so he recommended I not have surgery to repair it. I wish now I had gone on and had it repaired.

Fast forward a few years, my shoulders both still hurt from I assume arthritis and impingement syndrome I was told, so I gave up lifting.

Started lifting weights again a few years ago, but nothing with shoulders. Finally got tired of the pain in my right shoulder, so went to the Dr. Right bicep was tearing as well as a subscapularis. Had those surgically repaired in April of last year and couldn't be happier. Now my left should is giving me trouble a bit, so not sure how long before surgery is required there.

I went back to my ortho surgeon yesterday for a 10-week post-op follow-up. And everything is looking hunky-dory. Range of motion is good and healing is progressing well. The Doc took me off the hinged brace I'd been wearing for the last two months and he's increasing the amount of weight I can curl. I'm to increase incrementally to 10 lbs (up from 4) over the next month, then do 15 lbs for a month, then 20 lbs for a month, but I can only curl with hanging arms. No preacher's bench or arm blaster. And at the end of that third month I go back for another routine visit.

FWIW, I asked yesterday about the statistical chances of blowing it out again and he whipped out his smart phone and showed me two clinical studies, one citing 3% re-injury and the other a bit more than 1%. But he added that advanced age, smoking, obesity and steroid use all made re-injury more likely.

Glad you're doing better!

'Perciate it. I'm at the scary phase where I feel perfectly normal so I fear losing sight of the fact that I'm still a long ways from well-healed and doing something stupid to screw it up again. Yesterday my surgeon told me the story of one of his previous patients who decided to help his wife hang new drapes (a decision he probably didn't have much choice in). These were heavy drapes and his role involved him holding out the curtain rod (with curtains attached) in his fully-extended arms while the wife fitted the ends of the rod into the mounting fixtures in the wall. And with that visual in mind I'm sure you can guess the rest.

That was one bennie to always wearing the hinged brace. It was a constant reminder to go easy on the stupidity.

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Originally Posted by Beetlegeuse

'Perciate it. I'm at the scary phase where I feel perfectly normal so I fear losing sight of the fact that I'm still a long ways from well-healed and doing something stupid to screw it up again. Yesterday my surgeon told me the story of one of his previous patients who decided to help his wife hang new drapes (a decision he probably didn't have much choice in). These were heavy drapes and his role involved him holding out the curtain rod (with curtains attached) in his fully-extended arms while the wife fitted the ends of the rod into the mounting fixtures in the wall. And with that visual in mind I'm sure you can guess the rest.

That was one bennie to always wearing the hinged brace. It was a constant reminder to go easy on the stupidity.

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Good thing you are keeping that in mind. DONT rush it. That was my downfall Im sure. I had my shoulder replaced in 2018. My daughter got married 2 weeks after so of course I was in the wedding, not wearing my brace and moving it more than I should I got married about 3 weeks later and again, doing to much and not keeping it in my brace. I was supposed to go in on Jan 28th 2021 to have it all replaced and redone because the bicep and rotator cuff came detached. I had to reschedule to March 11th due to one of my coworkers got sick with covid who worked remotely so he was not able to come in and work for me.

I had my final follow-up today and am released to unlimited activity. Which makes about six months from the date of the injury. Until today I was limited to 15-lb curls, so I'll be easing back into it. I do have a degree of anxiety every time i pick up a dumbbell, not so much from fear of the pain as the shock of seeing my deformed arm, followed by another surgery with an extensive rehab period.

And Krb367, I got the gap, too. I thought maybe it was because they re-engineered the architecture, made it better than it was before, like Tommy John surgery. So I asked the doc about that today. He said it was just the natural consequence of tying off a tendon that's shorter than it use to be. I was never going to be in contention for Mr Olympia so no pain and full range of motion is the best I could hope for, and that I got.

No, Cylon357, I even stopped with the gear. A few years ago the VA refused to switch me from topical gel for my TRT to injectable because my Hct was too high. So I thought to take this opportunity to dry out so my Hct numbers would come down, figuring my total Test also would bottom out, so I'd have firm ground to stand on for the request. But somehow my Total T number was 340, which scuppered that plan.