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The Goalie Felt a Pop

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As the summer approaches, more and more of us are visiting the gym to hit the weights and tone our muscles for the beach. Injuries can occur when lifting weights, however, and it is important that we remember to use proper technique to minimize the chances of injury.

Ruptures of the biceps tendon at the elbow are one such injury that can occur with lifting heavy objects and predominantly affects middle-aged men. Martin Brodeur, the goalie for the NJ Devils hockey team suffered this injury earlier this season. Sudden forced extension of a flexed elbow can place extremely high loads on the tendon and cause it to rupture at the elbow, usually accompanied by a "pop" or traumatic tearing sensation. Usually this is accompanied by a visible "popeye" deformity as the muscle retracts into the upper arm, as well as a palpable defect at the elbow compared to the normal side. Frequently, the elbow and forearm region will get very "black and blue." Furthermore, rupture of the tendon leads to weakness with elbow flexion as well as forearm rotation and is usually poorly tolerated by most active individuals or manual laborers.

If a distal biceps tear is suspected, it is important to promptly seek the care of a physician. Often the diagnosis can be made by physical examination but MRI can be used to confirm the tear and assess the degree of tendon retraction from bone. Older patients with lower physical demands may opt for conservative treatment of such injuries, which includes physical therapy. Long-term, however, they may find that they are a bit weaker on the side with the torn tendon, and repetitive use of their biceps may result in cramping and easier fatigue.

With improved surgical techniques and implants that have helped to make distal biceps tendon repairs more minimally invasive, more patients are opting to have the tendon repaired back to its insertion on the radius bone in the forearm. Patients who elect for surgery need to have it done as soon as possible. Neglect for more than 3 or 4 weeks can lead to retraction of the muscle and scarring of the tendon, making a surgical repair of the tendon at the elbow difficult. Published results in medical literature clearly state that better functional outcomes are achieved when the surgery is done sooner. When treated appropriately, prompt recognition and repair can result in excellent cosmetic and functional outcomes in even the most active individuals. Martin Brodeur can attest to this, as he is already back minding the nets during the playoffs.

After surgery, patients are frequently protected in a hinged-elbow brace that allows motion within a protected range for the first 4 to 6 weeks after surgery, which gives time for the repaired tendon to heal. A progressive strengthening program is instituted, with the goal of getting patients back to their favorite activities by 3 to 4 months after surgery.

Of equal importance to injury recognition and treatment, however, is injury prevention. Use of proper technique when lifting and avoiding excessive weight, particularly in a deconditioned state, can help us to have a safe Spring while training for the Summer.

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