Closed proximal muscle rupture of the biceps brachii in wakeboarders

Abstract

Closed proximal muscle rupture of the biceps brachii is a rare injury. In this report, two cases of closed proximal muscle rupture of the biceps brachii after wakeboard traumas are described. Both patients presented with a swollen arm, weakness during flexion, and a mass in the affected forearm. Magnetic resonance imaging showed displacement of the biceps brachii into the forearm. The rupture was successfully treated with muscle removal in one case and muscle repair in the other. In patients with a wakeboard trauma and similar presentations, closed proximal muscle rupture of the biceps brachii should be suspected.

Musculotendinous Disorders in the Upper Extremity: Part 1. MRI of the Shoulder and Upper Arm

“…Severe transection of the biceps and brachialis muscles in the upper arm with possible neurovascular compromise has been reported in military parachute static jump-line injuries and wake-boarding tow rope handle injuries. [45][46][47] Ultrasound-guided aspiration of hematomas has become an increasingly common procedure, often with concomitant injection of medication (e.g., anesthetic, corticosteroid, plateletrich plasma). The suggested advantages of hematoma aspiration include an earlier return to activities and minimizing tissue fibrosis.…”

Surgical Treatment

“…The lesion of the biceps usually involves the tendon portion, more often the long proximal head and to a lesser extent the distal end that inserts into the radial tuberosity. Sometimes biceps muscle tears occur in the belly, especially when the arm remains entangled in ropes during some sports such as skydiving and wakeboarding [25,26]. Less frequently, the muscle belly can break following direct trauma in a car accident [27].…”

“…In the case of water sports such as water skiing or wakeboarders, the mechanism of injury is similar with the entrapment of the arm in a towline that pulls the athlete at great speed. What differs between the two sports is that the lesion usually reported in water sports causes a tearing injury in the proximal-distal direction of the biceps and is not as clear cut as the paratroopers; this sometimes may preclude the muscle suture and require muscle resection [26].…”

The Biceps Muscle from Shoulder to Elbow

“…Traumatic injuries to the biceps brachii muscle belly are rare but have been described in military static line parachute jumps, where the static line becomes wrapped around the upper arm, compressing the muscle against the humeral shaft and causing transection of the muscle belly. 35 More recently, rupture of the proximal muscle belly has also been described in wakeboarders, waterskiers, and other water sports utilizing a towline, 36 where the short and long heads may be stripped down to the forearm by the handle. Early diagnosis of muscle rupture is critical for successful surgical reattachment.…”