Expert: Dr. J. Shawn Leatherman - 8/13/2008

Question
While bowling last week I had a very sharp pain in my right arm that felt like a pinch.  I stopped bowling and tried to massage the area.  The pain was there but not noticeable unless I lifted the bowling ball with the same grip.  A day later I noticed a bruise in the center of my arm about 2 inches.  The following days the bruise got a little larger and also small brusing at the lower arm elbow.   The outer biceps muscle seems to have a bulge about half way down and I can feel it. I don't have any pain, so to speak of and I believe I have full strength. I went to the doctor today and he said I tore the muscle at the upper end and the bulge is the muscle that tore away.  He said that there is nothing that can be done for that type of tear.  I got him to refer me to a Ortho Dr so we will see.  My question is, how long will this heal and when can I start bowling with this arm again?  My age is 54 and I'm in good health.  When the bruising goes away will the arm be ready to use again if there is no pain while holding the ball?  Also, will my arm always have that bulge in it.  Thanks

Answer
Dear Kerry,

This will likely take 4-6 six weeks for the pain and swelling to subside, but if the biceps was completely torn, then the bulge will remain forever...like your doctor said, it is the remnant of the muscle under the skin balled up like a rubber band.  However, this will get smaller and less unsightly as time goes on due to the fact that the muscle will atrophy without use.  

The biceps brachii muscle has a single tendon at the elbow and two tendons (heads) at the shoulder.  The long head (outer) biceps tendon originates from the supraglenoid tubercle of the scapula, and the short head (inner)tendon from the coracoid process of the scapula. Rupture of the proximal biceps tendon accounts for around 95% of all biceps tendon ruptures with almost always exclusive involvement of the long head muscle tendon.If you've torn it, you will typically have pain and weakness with arm flexion.

Now you have a choice to make with the orthopedic doctor...to surgically repair or not.  Most of the time biceps tears are not full thickness and require no repair other than directed physical therapy.  Even when there is a full thickness tear, surgical repair is not likely unless you are a high level athlete because of the two heads:  one will tear while the other head remains intact, and the functional loss of strength is not great overall.  

From what you have described, the tear likely occurred in the tendon rather than the muscle belly, and this can be fixed surgically.  The orthopedic surgeon wold need to reattach the tendon at the origin on the bone near the shoulder blade or attach it to remaining fibers of the tendon and muscle...whatever is left. As a bowler, you may wish to have the biceps repaired due to the fact that it may disrupt your physical performance while bowling, but this is a decision only you and the surgeon can make. Definitely go to the appointment, and I would suggest that you get two opinions on this.

Good Luck Kerry.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net