Man With Right Arm Weakness

Article Outline

• Diagnosis
  • Ruptured right biceps tendon
• References
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[Ann Emerg Med. 2010;55:127.]

A 53-year-old man complained of right arm weakness. He “jammed” his right arm by yanking on a heavy machine at work several weeks earlier. The arm continued to feel weak, and he mentioned the problem in “quick care,” where he has presented for a cough and nasal congestion. He has no other medical problems. He smokes and drinks alcohol moderately. He takes no medications of any kind.

His physical examination revealed minimal nasal congestion, a few rhonchi with lung auscultation, and the 2 arms as revealed in Figure 1, Figure 2. No tenderness of the right arm was elicited. There was no other abnormality.

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• Figure 1. 

  Right arm.

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• Figure 2. 

  Left arm. Used with permission of James Webley, MD, Emergency Medicine Department, Genesys Regional Medical Center, Grand Blanc, MI.

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Diagnosis 

Ruptured right biceps tendon 

Deformity of the right biceps muscle with shortening and bunching distally is typical of a long head of biceps rupture.

The long head of biceps tendon is almost always the injured area (96%).¹ The usual patient is aged 40 to 60 years, with some chronic shoulder problems. Sudden pain while stressing the tendon, which rapidly diminishes, is the characteristic history.² A pop may be heard by the patient. Although there is some weakness, it rarely interferes with activities of daily living, and the injury is surprisingly well tolerated. Treatment often involves anti-inflammatory medications and physical therapy but may include surgery if supination strength is important.

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References 

1. Branch GL, Wieting JL. Biceps rupture. eMedicine Web site. http://emedicine.medscape.com/article/327119-overviewAccessed June 6, 2009
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2. Carter AM, Erickson SM. Proximal biceps tendon rupture primarily an injury of middle age. Physician Sports Med. 1999;27:95–102
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