Bicep injury - help / advice needed (with ultrasound scan pic)

DoubleM101

DoubleM101

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Hi guys,

So, long short story, i'm 40, i workout since my 30's and hopefully i can't say i ever had any big injury so far. Some minor injuries that fixed really fast.

However this time, i'm afraid it's another story.

Last week, on 6th, when i was jumping a gate, i missed a step and to not fall with my head, i was able to grab the fence with my left hand i got suspended by a few seconds until some friends helped me. As result, a chin and lip splint and had to take some stitches.

For the following days, my hand was in mild pain by grabbing the fence so hard to not fall and my arm hurted a little when i stretched it. But honestly i didn't care so much.

Two days after the fall, i was working out at gym and when i grab a light weight to do chest flies i felt a mild pain on my bicep/forearm but once again i thought it was due to be "forced" due to the fall, i stopped my chest workout and forgot it. However looking at the mirrow i noticed sometime very strange, it was like the Bicep long head wasn't present. Bicep was shortened. It didn't seem like rolled up but shortened by about 1cm. I have no idea if it was already like that after the fall but i only noticed it at the gym.

Two days after, i got the inner arm all bruised on forearm and bicep area and i realized something wasn't right. Medical appointment schedule to this Wednesday and started to google and i was really scared. Almost all if not all results were about Distal Tendon Rupture. I didn't sleep for some days until i got the appointment and doc said it probably could be only a partial rupture and even on the muscle, not on the tendon. Prescribed an ultrasound scan and i only got it today done because i almost beg it was an urgent thing... Most of health centers only had free slots for mid of March!

So, i asked during the ultrasound scan exam and doc told, it seems everything was fine with distal tendon but there was a small rupture on the muscle itself. I feel strange because all i find with these symptoms are related with distal tendon and not the muscle itself but i showed the result to a physio friend of mine and he told me it seems it's indeed on the muscle. I'm still waiting to have a new appointment with the ortho (only next week) but meanwhile i would like to know if you can give me some extra help / advise. Of course i'm not working out upperbody (except abs) and giving it some rest and Ice. Currently, pain is almost imperceptible except when someone touch me harder on bicep (where supposedly is the rupture) and it seems i feel some more fatigue when doing some repetitive movements. Everything else seems fine.

I attach a picture of the exam result (the one doc pointed the rupture but i can attack all the others 5 or 6) and one where the "shorted" bicep can be seen. Exam result says something like (i'll try by best translation from Portuguese): "On the distal third of brachial bicep muscle we notice a partial tear of 10.8mm without any other revelant alterations".

So what your personal opinion? It's in fact in the muscle itself? Can i expect it will heal with conservative treatment? About that "gap", will it eventually decrease with time? I'm in really low mood right now :(
 

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sillycibin

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So they think that is just swelling causing the deformity/distortion? Man it really looks contracted... If it is just a muscle tear then it should get better with conservative treatment but probably need to leave it alone for 4-6 weeks and then start back light for a couple weeks. You should probable get some opinions about PT, but you might need to at least do daily range of motion exercises. An MRI would give you a definitive answer as to what is going on. Much better than an ultrasound.
 
DoubleM101

DoubleM101

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Yeah ortho thinks it's "only" a muscle rupture/torn, whatever best called in english...

However i have some updates.

When ortho prescribed the ultrasound, i called multiple places to get it asap. I did the first one but since i already had another scheduled two days after, i still did it. In this ultrasound, doc told me distal tendon is really hard to check on ultrasounds but for what seems theres something not right but it was inconclusive. So, on the next ortho appointment, doc had two ultrasounds with opposite reports. Muscle rupture/torn is present on both reports (one reports 1cm, other 2cm) but distal tendon integrity not in accordance.

He made me some movement / strength tests, and it seems i still have full ROM, good strength and no pain in any movement. Still i have some random dull pain in bicep area (where the deformity can be seen). Bruises are gone for sometime. I had a PT to check and theres a spot where it really hurts when he touch me harder. It's hard describe exactly the spot but it's around where bicep should continue and "drops". Gap is still present but maybe it's already very very slightly "raised", not so depressed on some spots, but maybe it's me seeing things thats not there in hope everything is fine... mind can be tricky.

Meanwhile, i had today an MRI done and i'm still waiting for the report. However i asked doc who made it and she told me that it needs to be checked by other doc but for it seems and in her opinion it doesn't seems tendon was affected. At least it seems it's still attached to bone and theres no sign of rupture. I'm still not sure whats going on and now i can only wait for final report.

I'm not doing any upperbody workouts for about two weeks, only legs, cardio and abs and very light workouts, i had no motivation at all. I was maybe in the best "shape" and strength of my life, was planning to bulk for one more month and then do a cut... and now this happens. I already lost weight (about 3/4kg), some size but now honestly the only think i hope it's nothing major and i will recover 100% or at least near of it, no matter how long it will take.
 
big_jewels

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I understand the frustration, and yes it should heal with conservative treatment, but here are some extra tips, just do what you can with your other muscles, and actually keep working your opposite arm as it will transfer over to the arm you are not using, also make sure to keep your eating on point and a little higher clean calories to help with compensate for the bodies healing , this will help mitigate muscle loss and heal, after about a week of heat or ice, or both, do some self massage along the grains of the muscle to help lengthen it again as well. Then as directed by a professional as sillycibin said they can tell you when you can take your arm through more range of motion and stretch. If it still is having trouble healing then there is unconservative treatments you could look at.
 
DoubleM101

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Hi guys, thanks all for your comments.

I got the MRI report and for what it seems it was a "partial?" but almost total rupture of muscle.

I'll try to translate the best i can:

An image compatible with practically complete rupture in the tendinous muscle transition of the bicipete in its
distal portion showing no retraction of the muscular body, probably due to the conservation of the lacertus fibrosus.
A small liquid collection is observed surrounding the tendon muscle transition.
The brachial muscle and its tendon reveals a conserved aspect.
There is no pathology of the triceps tendon and its own muscle.
I do not observe collection between the muscular planes.
No other changes are observed.
CONCLUSION: Almost a complete rupture in the tendinous muscle transition of the biceps without other changes

I have no idea what to think.. It seems it wasn't a total but almost? At least tendon seems ok but now i'm really afraid that it will not recovery with conservative treatment...

Anyone recovered with conservative treatment with something like this?
 
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sillycibin

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Definitely need an orthopedists opinion and develop a treatment plan. Sounds like a bad injury and you could make it worse if you are too aggressive too soon. Could be looking at 2-3 months minimal activity followed by 2-3 months light to moderate activity and not returning to full unrestricted use for a while. You need a schedule for advancement of activity and at least an initial physical therapy consultation so you can get some exercises and understand what to do and what not to do.
 
DoubleM101

DoubleM101

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Today i got an appointment with the orthopedist and looking at MRI results, he told me attending it wasn't a full rupture and it was in the tendinous muscle transition area, we should try conservative treatment because recovery should be reasonably good and for what i understood, there isn't a "good" surgery for it.

So, he recommended absolutely no weight lifting (not only on gym but also on daily tasks) with that arm to get no risk of full rupture. I can and i should do normal movements but with no weight. An ultrasound booked in 6 weeks to see how it's going and then we will see the protocol to follow. Until there no physio also.

Since he seems to be an "acessible" and "young" doc i told him i was taking Mk677 hoping to heal better and faster and he told me to avoid anything that promoves muscle grow but since MK677 seems to have healing effects i could try it.

I didn't talk about any other supplements but i'm also taking a multivitaminic, 1g of Vitamin C and Omega 6. In addition i have in the shelf intranasal BCP-157 (i'm aware of all the controversy around nasal/oral bioavailability) and ostarine i was planning to use for a cut in a couple of months. But i'm not sure if i should use them or keep only with i'm currently taking.
 
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sillycibin

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Today i got an appointment with the orthopedist and looking at MRI results, he told me attending it wasn't a full rupture and it was in the tendinous muscle transition area, we should try conservative treatment because recovery should be reasonably good and for what i understood, there isn't a "good" surgery for it.

So, he recommended absolutely no weight lifting (not only on gym but also on daily tasks) with that arm to get no risk of full rupture. I can and i should do normal movements but with no weight. An ultrasound booked in 6 weeks to see how it's going and then we will see the protocol to follow. Until there no physio also.

Since he seems to be an "acessible" and "young" doc i told him i was taking Mk677 hoping to heal better and faster and he told me to avoid anything that promoves muscle grow but since MK677 seems to have healing effects i could try it.

I didn't talk about any other supplements but i'm also taking a multivitaminic, 1g of Vitamin C and Omega 6. In addition i have in the shelf intranasal BCP-157 (i'm aware of all the controversy around nasal/oral bioavailability) and ostarine i was planning to use for a cut in a couple of months. But i'm not sure if i should use them or keep only with i'm currently taking.
As someone who works in healthcare I always laugh at the "discuss with your doctor" labels or advice... if something is not standard practice, protocol or guideline recommended by a major medical group, then the answer is you shouldn't do it. doctors only stick with what is established and do not speculate or experiment and they are always concerned about getting sued. because it does happen and law suits are big deals whether they are truly justified or not because juries can be manipulated by sad stories and when doctors get sued it makes it harder and more expensive to get malpractice insurance which they cannot practice their profession without. and these are people who invest 10+ years and $200-300k to do what they do. so no, they don't mess around with stuff they don't know about.
 
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