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Cure Of Proximal Reinsertion Of The Biceps Brahial Muscle

Article written by: ANDREI BOGDAN, MD, Orthopedics-traumatology doctor

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For all traumatic or chronic diseases of the musculoskeletal system, the Centrokinetic private clinic in Bucharest is prepared with an integrated Orthopedic Department, which offers all the necessary services to the patient, from diagnosis to complete recovery.

The Department of Orthopedic Surgery of Centrokinetic is dedicated to providing excellent patient care and exceptional education for young physicians in the fields of orthopedic surgery and musculoskeletal medicine.

Centrokinetic attaches great importance to the entire medical act: investigations necessary for correct diagnosis (ultrasound, MRI), surgery, and postoperative recovery.

Discover the open MRI imaging center in our clinic. Centrokinetic has a state-of-the-art MRI machine, dedicated to musculoskeletal conditions, in the upper and lower limbs. The MRI machine is open so that people suffering from claustrophobia can do this investigation. The examination duration is, on average, 20 minutes.

The shoulder joint offers such a large area of movement and much greater flexibility than other joints in the body, being consequently the joint most prone to dislocations and subluxations. Repeated or acute trauma, scapulohumeral dislocations, or congenital laxity of the soft parts can lead to a rupture of the long head of the brachial biceps muscle, associated or not with other injuries (anterior dislocation of the shoulder, rupture of the rotator cuff).

The brachial biceps, one of the dominant muscles of the arm, is involved in the functional activities of the upper limb, both due to its size and due to the orientation towards the shoulder and elbow joints. In the proximal extremity, the biceps has two distinct tendon insertions on the scapula, which extend the long head and short head of the brachial biceps.

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A proximal rupture of the brachial biceps muscle involves an injury to the shoulder, through which the long head of the muscle dissipated from the scapula. It most often occurs in middle-aged people and usually occurs due to repeated stress, being a degenerative injury. In young people, the rupture occurs as a result of sports accidents: weight lifting, sudden, intense muscle contraction in the arm (eg: elbow fall in extension).

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The incidence of tendon ruptures of the long head of the brachial biceps is constantly increasing. Most brachial biceps ruptures occur in adults between the ages of 40 and 60, who have a history of shoulder symptoms. The dominant arm is most commonly involved, probably due to overuse, compared to the non-dominant arm. Long head fractures occur in 96% of total brachial biceps fractures, while the percentage of distal tendon rupture and short head rupture is 3% and 1%, respectively.

The treatment can be orthopedic or surgical.

Non-surgical / orthopedic treatment

Our medical team usually approaches this pathology without surgery, but the therapeutic indication depends on the patient's age and the degree of activity. Without surgery to fix the ruptured tendon, the patient loses some of the muscle strength of the arm. The short head of the biceps is still attached and continues its function during flexion so that the rupture of the long head of the muscle will only cause a decrease in muscle strength, not total functional impotence (impossibility to perform certain movements). Elbow flexion may be affected, but the twisting movement of the forearm, such as when using a screwdriver, is usually more affected.

Non-surgical measures could include a phase to support the shoulder. Patients may receive anti-inflammatory medications that will help reduce pain. Our medical team recommends patients follow a recovery treatment after the immobilization period.

In the beginning, our physical therapists will give you advice on how to rest your shoulder and how to do light exercises, and in daily activities do not put extra pressure on the swollen area. Our medical team can apply ice (cryotherapy) and electrical stimulation to relieve your pain. Exercise is used to gradually tone the muscles.

Surgical treatment

The surgery is reserved for young patients, under 50 years old and active patients, athletes regardless of age (for example a 60-year-old patient who plays tennis twice a week, indicates reinsertion).

Tenodese

It is a surgery performed to anchor the broken end of the biceps tendon. A common method, which involves anchoring the torn tendon to the humeral head. The interview can be done classically or arthroscopically. Our medical team starts by making an incision on the front of the shoulder, just above the armpit, after first palpating the tendon. The superficial muscles are separated so that we can locate the damaged end of the biceps tendon. The end of the tendon is repaired by removing damaged tissue and reinserting it with a special anchor.

After surgery

Immediately after the operation, you will need to wear a shoulder strap for about four weeks. We prefer that all patients begin a light exercise program shortly after surgery. When you begin recovery visits, the first sessions will involve ice treatments (cryotherapy) and electrical stimulation (TENS, CIF) to help control pain from surgery. Our physiotherapists can also use massages and other treatments to relieve muscle spasms and pain.

You will gradually begin to perform exercises to improve circulation in the forearm, elbow, and shoulder. Heavier exercises for the biceps muscle are avoided at least four or six weeks after surgery. Our medical team will start with light toning exercises. These exercises work the biceps muscle without involving the tendon being healed. At about six weeks, start toning more actively. As you progress, we will teach you exercises to tone and stabilize your elbow and shoulder muscles and joints. Some exercises will help you move your hand in ways that are similar to the tasks at work and the sports activities you are used to doing. We will help you find ways to do your daily tasks without putting too much emphasis on your shoulder.

It generally takes three to four months after surgery before you can start doing more biceps exercises. Before the end of therapy sessions, we will teach you several ways you can avoid future problems.

Following any surgery, medical recovery plays an essential role in the social, professional, and family reintegration of the patient. Because we pursue the optimal outcome for each patient entering the clinic, recovery medicine from Centrokinetic is based on a team of experienced physicians and physical therapists and standardized medical protocols.
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