Distal Biceps Tendon Repair Advice?

[tball]

Does anyone have experience with a ruptured distal biceps tendon? I'm pretty sure I've got one.

Yesterday, I was bopping along in some spring bumps, nothing out of routine. I did a pole plant and felt a pop near my right elbow then severe pain in my arm. Each right pole plant hurt like hell when I tried to ski again. I lost the poles, and I kept skiing, then drove back to Denver fine.

This morning, my arm still hurt and isn't working right. After a bit of research, it sounds like it's pretty serious. There is a "hook test" where you check for the attachment of the distal biceps tendon. I can hook the tendon on my left arm, but it's nowhere to be found on my right.

It sounds like surgery is the only option to regain full use of my arm. Any suggestions on surgeons in the Denver area? I've found a few that mention biceps tendon repairs, but it's relatively rare. Everybody seems to focus on knees and shoulders. Elbows and other body parts don't seem to get as much love.

There is a famous guy in Vail, but I'd rather not get it done there logistically and for some other reasons. There has to be someone good in Denver that can fix it? From what I've read, I need to have surgery soon, so any help is much appreciated!

 

[SBrown]

Try the guys from Panorama. I've always had good experiences with Panorama, better than some of the other well-known outfits. I haven't had surgery there, but my husband and son have had two knee surgeries each. Dr Froelich treated my daughter for a minor wrist break, but I'm pretty sure he has operated on @dondenver . Rowland dealt with some wrist injuries I had, but no surgery. The other hand guy on their team appears to specialize in elbows, too, not just hand and wrist. Good luck. That stinks!!

 

[Ron]

Steadman, Hackett or Millett

https://www.vailhealth.org/services/orthopaedics/the-steadman-clinic

Keep in mind its ACL season so everyone is busy right now.

 

[tball]

Update: my arm is feeling much better today. Less pain, more functional, and RICE, Tylenol and ibuprofen.are helping.

Thank goodness for the Internet. I otherwise I wouldn't believe I likely need surgery soon to prevent significant loss of the use of my arm. It doesn't feel that bad, and I doubt I'd see a doctor otherwise until it was too late.

My wife rolled her eyes at my self-diagnosis and needed surgery. Then she looked at my arm and said: "you got to get that fixed."

In addition to failing the hook test, I've got a nice size ecchymosis (bruise from internal bleeding), and a reverse Popeye deformity.

Here's the best description of the injury and how to diagnose I found in case anyone thinks they might have the same:


And some pictures of the skiing conditions if anyone is curious and for my future reference:
https://www.pugski.com/threads/2017-18-colorado-weather-and-stoke.5553/page-114#post-229594

Thanks so much for the suggestions @SBrown and @Ron and the reminder it's ACL season. I've finalized a list of docs to call first thing in the morning. I'm afraid it's going to Black & Blue Monday after spring break and hoping I'll get through and in with a good surgeon soon.

 

[Kneale Brownson]

They probably won't want to do surgery until after the bruising/swelling subsides. I'd second Ron's suggestion of Tom Hackett. He repairs knees, shoulders AND elbows.

And why are you doing "pole plants" instead of pole touches?

 

[Ron]

@tball we need a pic bro'

 

[tball]

@tball we need a pic bro'

Just a few hours late.

 

[Ron]

I meant of your bicep

 

[tball]

I know, that was lame belated April fools.

 

[Ron]

yep she's toast!

 

[tball]

I'm seeing Dr. Wolcott with CU tomorrow. I've seen her before and really liked her, and overjoyed to get in so quickly.

Thanks so much for the other recs. After sleeping on it and for some reasons I'd rather not go into here I want to have it fixed at the Anschutz mothership rather than a surgery center or Vail. Happy to tell ya'll the gory details riding a chairlift sometime.

I'm going to ask her about also fixing my torn meniscus at the same time (confirmed with an MRI last year). Has anyone tried a double? Any thoughts? Crazy? I'd rather be laid up once than twice, if possible.

She seems competent at both. She gave a talk a few years ago about the biceps tendon repair:
http://www.ucdenver.edu/academics/colleges/medicine/sportsmed/cusm_events/2014SportsMedSymp/Documents/2016/12 - CU Fall Symposium - Wolcott.pdf

And last year about meniscus repair:

 

[Ron]

well,meniscus tears are common and only need to be repaired if they are causing issues. that's something to discuss with your OS. Best of luck to you!

 

[Jenny]

My husband partially tore his bicep tendon a few years ago, but it was up near the shoulder end, not near the elbow. Surgery in mid-late October, skiing in late Jan. They didn’t repair it, rather they cut it the rest of the way and then stuffed the end into a hole in the bone, with a plug (I assume of the bone they took out when they made the hole), so it would create a new anchor point. Evidently when you’re our age, that heals better than trying to put it back together. (Disclaimer - this is how I understand what happened, anyway. I'm sure there’s a much more technical explanation.)

 

[tball]

And why are you doing "pole plants" instead of pole touches?

Yeah, I need to revisit my pole plants.

I've always planted more on the uphill side of the bump than on the suggested top or downhill side. I thought whatever, it's working for me.

Now in retrospect and looking at some of my video my plants have been much higher impact than necessary. I think, maybe, zillions of pole plants like that took a toll on my tendon. Or bad luck, or genetics, or too much weight lifting as you can see from my massive arms.

I also think my poles are too long. I've been meaning to cut them down since reading the shorter pole thread (or whatever it's titled). I think my exact same technique with shorter poles might land my plants on the top of bumps rather than the uphill side, making them lower impact touches.

That said, it wasn't a violent plant when my tendon popped, rather quite ordinary. Seems like it was hanging on by a thread and would have ruptured doing yard work or whatever.

It's certainly possible years of high impact pole plants caused or contributed to the injury. In general, pole plants are a higher impact on the triceps than biceps, but when skiing fast the hand motion to move the pole forward does put some force on the biceps, obviously, especially when the tip sticks in the snow as it was on that run.

I'll start a ski school thread at some point for some summer entertainment: Bumps, Hands, Pole Length, and a Torn Biceps Tendon.

 

[Kneale Brownson]

I'd wonder about using crutches after the meniscus repair if you're still recovering from the elbow repair.

 

[tball]

Surgery set for Thursday next week.

Very straightforward diagnosis through a physical exam (same as in the video above). Will do an MRI for preop planning to confirm there is enough tendon remaining to fix without a graft. She does the button technique that results in an extremely durable fix, enjoys doing this surgery (whatever that means ), and does a lot of them. The most common complication is nerve damage resulting in forearm numbness, around 5%.

She prefers to do the surgery 1-2 weeks after the injury, so I'm right there. That gives time for a little scar tissue to form on the tendon making it easy to suture, but before it retracts requiring a graft.

Recovery is six weeks of not lifting anything with decreasing degrees of immobilization. Six months back to full strength. Probably some rehab, we'll see.

Not getting it fixed isn't a good option. Too much arm disability.

I'd wonder about using crutches after the meniscus repair if you're still recovering from the elbow repair.

You're spot on. That's why it took her about one second to say no to fixing my meniscus at the same time.

I'm sure I'd be fine having two extremities immobilized simultaneously, but she didn't like the idea.

 

[Ron]

Best of luck!

 

[Kneale Brownson]

You'd be fine as long as your wife would wheel you around in a chair and lift you on and off the toilet

If you were thinking crutch-in-armpit, know that that would be both hazardous and painful.

 

[Tim Hodgson]

Dang! Shouldn't this be renamed the "old guys' subforum?"
(If I am not careful, I will spend all my time on PugSki in this forum...)
Does your biceps look like the picture of this one which I pulled from the internet?

If so, welcome to the club! I have two of them, both popped while doing hard forward strokes trying to stay on a wave while whitewater kayaking. When I look at how the long head of the biceps attaches, I can see why 30 years of whitewater kayaking would wear through the attachment.

I have since accepted my "Popeye" biceps. It is now the least of my worries.

You will be ok, but mortality sucks.
(Christianity makes it better.)

 

[SBrown]

...
I'm sure I'd be fine having two extremities immobilized simultaneously, but she didn't like the idea.

Don't you have two little kids?!?! lol

(And best of luck next week)