Distal Biceps Tears in Combat Athletes

Distal Biceps Tears In Combat Athletes
By Steve A. Mora, M.D.

Tendon and ligament tears are relatively common injuries in Mixed Martial Arts (MMA). Some of the MMA soft tissue injuries I frequently treat include torn tendons such as pectoralis major tendon tears, capsular tears of the shoulder and elbow, and distal biceps tears. Competitive mixed martial arts requires major upper body strength which is often resisted by the opposing athlete. In the non MMA population distal biceps tears usually occur in men aged 40-60. I have seen many young MMA athletes younger than 40 years of age suffer a distal biceps tear. I also see these injuries in people who injure themselves during hand to hand combat training. Distal biceps tears usually occur as the elbow is straightened against resistance. For example if a fighter’s arm is straightened out in a fast and forceful manner it will cause the tendon to pull itself off the bone. Imagine a fighter who fails to protect his or her arm from an arm bar. As the flexed arm is straitened it creates extreme tension on the tendon causing it to snap off the bone. This can also happen when a fighter throws a hook and suddenly the arm is blocked in such a way that it causes the arm to partially straighten out. Sometimes the biceps will tear from lifting (curling maneuver) an opponent who suddenly holds on to the cage while he or she is being lifted.

Once torn, the distal biceps tendon tears will not grow back to the bone and heal. Other arm muscles make it possible to bend the elbow fairly well without the biceps for this reason the tear can hard to identify. However, they cannot fulfill all the functions, especially the motion of rotating the forearm from palm down to palm up. This is called supination. Significant, permanent weakness during supination (opending a jar motion) will occur if this tendon is not surgically repaired. In addition to the loss of flexion strength, the arm will take on undesirable “Popeye” appearance.

Typical History:  

*Athlete felt severe pain and pop over anterior elbow region while doing a forceful activity

*Immediate bruising and inability to move elbow will occur

*Biceps muscle seems to be floppy and a little higher than normal (this will not be noticeable until swelling goes down)

*In many cases the natural up/down motion of the muscle will not be possible as the wrist is rotated.

Examination:

This simple test can help identify complete distal biceps tears. Please see my youtube.com link on the BUD test: http://youtu.be/UcQBj9ebwEo

If you think you have a distal biceps tear you should get in to see a Orthopedic Surgeon ASAP.

One of the biggest problems with these injuries is that they are frequently misdiagnosed.  Once the swelling pain and bruising subsides the patient may think everything is fine.  In some situations the patient is not properly counseled by their medical provider so the injury is  understated. The reason why these injuries require immediate attention is that the likelihood of full recovery after expeditious surgery is high however if the tear is misdiagnosed it may become too scarred up to re attach to the bone 

Treatment:  Complete ruptures of the distal biceps are treated with surgery.  Surgery should be done within the first few days from injury. The longer one waits for treatment the higher likelihood the tear will not be repairable. Partial tears might be treatable with activity modification and rehabilitation.  In some cases a near complete tear may also be treated with surgery.

Surgery requires a incision near the elbow crease.  The tendon is pulled out, tagged with sutures and re attached to the radius bone.  The re attachment may be done in a variety of ways including anchors, buttons, or drill holes.  The incision is usually 2-3 inches over the front of the elbow near the crease.  If the repair is rock solid a arm sling is worn for a short period of 1-2 weeks.  The initial rehab focus is on stretching and soft tissue work.  It is usually safe to start very light lifting at 6 weeks.  By 6 months the repair is solid enough to do most activities including.

If the diagnosis is made early and accurately patients can regain full function and strength.  

I hope you found this information useful.  If you have questions send them to me on Twitter (@myorthodoc) or Facebook.com/myorthodoc.

I hope you found this information helpful.

About Steve A. Mora MD:

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Dr. Mora is a native of Orange County. He graduated from Anaheim High School in Orange County CA. He completed his training at the UC Irvine where he finished in the top of his class with AOA Medical Society honors. He completed his Orthopedic Surgery training USC. He completed an extra year of training with a Sports Medicine, Cartilage, Shoulder, and Knee Fellowship at Santa Monica Orthopaedic and Sports Medical Group. He is currently practicing Orthopedic Surgery in Orange County. Dr. Mora’s practice focus on sports related trauma, knee ligament and cartilage repair, shoulder rotator cuff and instability, hip arthroscopy and partial knee replacement. He sees athletes of all levels including professional soccer and UFC/MMA. He is team doctor for the Anaheim Bolts pro indoor soccer team and Foothill High School. Dr. Mora performs Cartilage transplantation (Genzyme), partial custom knee replacement, OATS, tibial osteotomies, meniscus transplant, ACL reconstruction, shoulder reconstruction, elbow arthroscopy, hip arthroscopy, platelet rich plasma and adult stem cell injections. Dr. Mora’s family heritage is Peruvian. He speaks fluent Spanish.

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