Patient Information Resources

Alpine Physical Therapy
Three Locations
In North, South, and Downtown Missoula
Missoula, MT 59804
Ph: 406-251-2323
Fax: 406-251-2999

Child Orthopedics
Pain Management
Spine - Cervical
Spine - General
Spine - Lumbar
Spine - Thoracic

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I was pouring cement for my new deck and felt a tearing, pulling sensation in my right elbow. It happened just as I was lifting the wheelbarrow up to unload the cement. I finished the project but my arm is screaming at me and I have no strength left at all. What do you think happened?

The symptoms you describe: a tearing sensation, pain, and weakness could be an indication of soft tissue damage. You'll need an examination by an orthopedic surgeon to know for sure. Given the mechanism of injury (arms extended with a force applied to the elbow during the lift), the most likely area affected is the distal biceps tendon. The biceps muscle goes from the shoulder to the elbow on the front of the upper arm. It is attached to the bone by tendons at the top and bottom. Two separate tendons connect the upper part of the biceps muscle to the shoulder. One tendon connects the lower (distal) end of the biceps to the elbow. A distal biceps rupture occurs when the tendon attaching the biceps muscle to the elbow is torn from the bone. A distal biceps rupture is rare compared to ruptures where the top of the biceps connects at the shoulder. This injury occurs mainly in middle-aged men during heavy work or lifting. Similar injuries in women are extremely rare. Smokers are more 7.5 times more likely to rupture the distal biceps tendon than nonsmokers. The diagnosis is made using a combination of patient history, visual inspection, palpation, clinical tests, and imaging studies. The history is often an important clue because patients usually describe a sudden force applied to the arm followed by a tearing sensation on the inside of the elbow. There is immediate pain and then weakness when trying to bend the elbow. Two clinical tests that are very useful are the squeeze test and the hook test. You can actually do these tests on yourself to try them out. The squeeze test is done by using one hand to squeeze the upper portion of the biceps muscle of the other arm. You'll see and feel the hand of the arm being squeezed turn slightly toward a palms up position. This happens automatically when the muscle is squeezed. The hook test is done with the elbow slightly bent. Use your fingers of the opposite hand and feel the tendon as it attaches to the front of the elbow. You can actually use your index finger to grab or "hook" that tendon and pull it up. If the tendon is ruptured, you won't be able to see the hand turn when you squeeze the biceps muscle and you won't be able to find the tendon to hook a finger under it. To confirm the diagnosis, the surgeon can order MRIs, which will show exactly what's happening in the soft tissues around the elbow. Of course, the diagnosis is confirmed if/when surgery is done. But sometimes, operative repair isn't needed. The surgeon who examines you will give you the proper diagnosis and proposed plan of care. Don't put it off as early diagnosis and treatment can improve your odds of good outcomes.


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