MANUAL MINORS
Injuries to the biceps and brachialis muscles often result from overuse, acute trauma, or repetitive movements. The biceps muscle enables elbow flexion and forearm supination, while the brachialis is primarily responsible for elbow flexion.
Injuries may include partial or complete tears of the distal biceps tendon, muscle strains, or brachialis muscle injuries, which typically cause pain, swelling, and weakness in elbow function.
Diagnosis
The diagnosis is based on a history of acute pain, weakness, and sometimes an audible snap associated with elbow use, especially when lifting heavy objects. Physical examination may reveal a bulge in the arm (if there is a complete rupture of the distal biceps tendon) or localised pain in the front of the arm. Magnetic resonance imaging (MRI) or ultrasound helps confirm the extent of the injury, particularly in cases of partial or complete tears.
Differential Diagnosis
Pathology | Characteristics |
|---|---|
Distal biceps tendon rupture | Acute pain with a visible “bulge” in the arm and weakness when supinating or flexing |
Medial epicondylitis | Pain on the inner side of the elbow, associated with repetitive wrist flexion |
Medial collateral ligament sprain | Pain on the inner side of the elbow, common in throwing sports |
Biceps tendinitis | Chronic pain at the tendon insertion, without visible deformity |
Radial nerve injury | Pain and weakness when extending the arm, without muscle deformity |
Emergency Management
Initial emergency management includes immobilising the arm to reduce pain and prevent elbow movement. Analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) are administered to control pain and inflammation. If a distal biceps tendon rupture is suspected, the patient should be urgently referred to an orthopaedic surgeon, as early surgical repair yields better outcomes.
Definitive Treatment
Definitive treatment for partial tears or strains includes rest, physiotherapy to restore strength and mobility, and the use of NSAIDs. In cases of complete distal biceps tendon rupture, surgical treatment is required to reattach the tendon to the bone.
Postoperative rehabilitation is essential for regaining strength and elbow function, with a gradual progression of strengthening exercises. Surgical intervention for brachialis injuries is rarely needed, but physiotherapy and pain management are important for recovery.
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