Brief Outline of Bicipital Tendinitis

Bicipital tendinitis results from irritation and inflammation to the biceps brachii tendon, which has lies on the front of the shoulder and allows bending of the elbow and supination of the forearm. Overuse can lead to inflammation and is a common affliction in golfers, weight lifters, rowers, and those engaged in throwing sports.

Anatomy and physiology

Tendons are tough, resilient bands of fibrous tissue, connecting muscle to the bone. Irritation of the tendon due to overuse occurs as it passes back and forth in the intertubercular (bicipital) groove of the humerus, and can cause inflammation of the tendons (known as tendinitis) as well as the tendon sheaths or paratenons. The musculo-tendinous junction of the biceps brachii is highly susceptible to injuries brought on by overuse, particularly following repetitive lifting activities.

Cause of Bicipital Tendinitis

Poor technique, particularly in weight lifting. Sudden increase in duration or intensify of training. Impingement syndrome.

Signs and symptoms

Pain over the biceiptal groove where the tendon is passively stretched, and during resisted supination and elbow flexion. Pain and tenderness along the tendon length. Stiffmess following exercise.

Complications if left unattended

Bicipital tendinitis, left without care and treatment, generally worsens as the biceps brachii tendon becomes increasingly irritated and inflamed. Movement and the ability to perform athletically without pain will be furthered hampered. Exercising without adequate healing rehabilitation can lead to tearing of the tendon and tendon degeneration over time.

Treatment

Rehabilitation and prevention

The condition is self-limiting given rest and minimal medical attention. Following full recovery, exercises directed at improving flexibility, propioception, and strength may be undertaken. Thorough warming-up and stretching exercises and a steady athletic regimen that avoids sudden, unprepared increases in activity can help avoid this injury, as can attention to proper sports technique.

Long-term prognosis

A full return to athletic activity may generally be expected,  given adequate time for tendon recovery and reduction of inflammation. However, the injury is frequently recurrent. Surgery is generally not required. Injections of anti-inflammatories are sometimes used to reduce pain and inflammation.

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Brief Outline of Biceps Brachii Bruise

Bruising to the biceps brachii can occur following tearing and/or rupture of the biceps brachii tendon, or trauma to the muscle. The biceps brachii tendon attaches the biceps brachii muscle to bone in the shoulder region. Overstrain from weight training can cause tears and bruising, which may also result from throwing sports or following direct trauma to the shoulder during a fall or collision with another athlete.

Anatomy and physiology

The biceps brachii muscle is located on the front of the upper arm, and operates over three joints. Its function is to allow bending of the arm and to support loads places on the arm. This muscle has two parts, known as the long head and short head, both connected to bone via the biceps brachii tendon. This muscle runs down the anterior or front side of the upper arm and allows motion of the forearm towards the shoulder (elbow flexion). The biceps brachii muscle also allows turning the hand face down or face up. This is known as pronation or supination of the forearm.

Cause of Biceps Brachii Bruise

Direct blow to the biceps brachii region of the upper arm. Biceps brachii rupture. Repetitive tearing of the biceps brachii muscle or tendon.

Signs and symptoms

Discolouration of the biceps brachii area. Aches or pain in the biceps brachii. Stiffness and limitations of movement in the affected arm and shoulder.

Complications if left unattended

Bruising of the biceps brachii generally resolves itself without treatment. Sports involving heavy use of the biceps brachii muscle including weight training and throwing sports, and contact activities with high risk to the biceps should be avoided pending adequate time for healing.

Treatment

  • Immobilisation with a sling to prevent excess movement
  • Physiotherapy

Rehabilitation and prevention

Rest and avoidance of activities involving stress to the biceps brachii muscle and tendons during the healing phase are generally sufficient. Range of motion exercises and graded strength training should be undertaken to restore full power and resilience to the muscle. Stretching exercises performed before athletic activity may help prevent injury and associated bruising to the biceps brachii.

Long-term prognosis

Bruising to the biceps brachii is generally a minor condition that is self-correcting without resort to surgery, given adequate time for healing. No long-term deficit in strength or mobility is expected.

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Brief Outline of Biceps Brachii Tendon Rupture

Repetitive strain, particularly due to overlifting, can lead to irritation and microscopic tears in the biceps brachii tendon, which connects the biceps brachii muscle to the shoulder joint at the proximal end and the elbow at the muscle’s distal end. A biceps brachii tendon rupture results from sudden trauma to the biceps brachii tendon causing its detachment from the bone. Injury at the proximal (shoulder) end of the tendon is most common. Biceps brachii tendon ruptures can occur from weight lifting or throwing sports, but are generally uncommon, particularly young athletes.

Shoulder Biceps Rupture Symptoms

 

Anatomy and physiology

The biceps brachii muscle is located on the front of the upper arm, and operates over three joints. Its function is to allow bending of the arm and to support loads placed on the arm. This muscle has two parts, known as the long head and short head, both connected to bone via the biceps brachii tendon. Rupture of the tendon prevents the muscle from pulling on the bone, thereby restricting movement. In older individuals, it is often the result of degenerative change in the tendon.

Cause of Biceps Brachii Tendon Rupture

Weakness due to tears in the rotator cuff. Throwing activities. Weightlifting.

Signs and symptoms

Bulge in the upper arm. Inability to turn the palm upward or downward. Sudden, sharp pain at the shoulder.

Complications if left unattended

Generally, little functional loss accompanies rupture of a proximal biceps brachii tendon, as two tendinous attachment occur at the shoulder, one compensating the other in most cases. For this reason, surgery is rarely required and complications are rare, though without proper healing, re-tearing and degeneration of the tendon are more likely.

Treatment

  • Immobilisation for partial tear to the biceps tendon rupture
  • Surgery for full tear

Rehabilitation and prevention

Following rest and recovery of the tendon, flexibility and strengthening exercises should be undertaken to restore full mobility in the shoulder. Avoidance of sudden lifting beyond normal capacity and other sudden violence to the biceps brachii tendon as during throwing sports may help prevent the injury.

Long-term prognosis

Most biceps brachii tendon ruptures resolve themselves without medical intervention if given proper time for healing. In younger athletes with demanding training schedules, surgery may be contemplated to repair the rupture. Tears and ruptures to the distal end of the biceps brachii tendon at the elbow are more rare, but can be more severe, requiring surgery. However, in both cases the prospects for full recovery are excellent.

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Biceps Femoris Avulsion Fracture

Brief Outline of Biceps Femoris Avulsion Fracture

An avulsion fracture occurs when a tendon or ligament pulls away from the bone at its attachment, pulling a piece of the bone away with it. This usually results from a forceful, twisting muscular contraction or a powerful hyperextension or hyperflexion of the knee. The injury is more prevalent in children than adults: in adults the tendons or ligaments tend to tear before the bone is affected, whereas the softer bones tend to become involved in children’s injuries.

Biceps Femoris Avulsion Fracture

Cause of Biceps Femoris Avulsion Fracture

Forceful twisting, extension, or flexion, causing extra stress on the tendon. Direct impact on the knee, causing forceful stretching of the biceps femoris tendon.

Signs and Symptoms of Biceps Femoris Avulsion Fracture

Pain at the back of the knee. Swelling and tenderness. Loss of hamstring strength and decreased ability to flex the knee.

Complications If Left Biceps Femoris Avulsion Fracture Unattended

When left untreated an avulsion fracture will lead to long-term disability in the hamstrings and knee joint. Incomplete or incorrect healing may result as well, leading to future injuries of the knee and other muscles around the joint.

Immediate Treatment for Biceps Femoris Avulsion Fracture

R.I.C.E. Immobilisation of the knee joint. Anti-inflammatory medicines. Seek immediate medical help.

Rehabilitation and Prevention for Biceps Femoris Avulsion Fracture

Rest for the injured knee and then strengthening the muscles and supporting ligaments will help rehabilitate and prevent future fractures. Gradual re-entry into full activity is important to  prevent re-injuring the weakened area.

Long-term Prognosis and Surgery for Biceps Femoris Avulsion Fracture

With proper treatment most simple avulsion fractures will heal completely with no limitations. In rare cases surgery may be needed to repair the avulsed bone, especially in children when the avulsion involves a growth plate.

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