1. Rupture of tendons Muhammad Farrukh Bashir FCPS(ortho) Muhammad Farrukh Bashir FCPS(ortho)

2. Tendons mostly rupture Upper limb: daltoid,biceps,triceps Lower limb:quadriceps,hams,tendoachllies.

3. What is the biceps muscle? The biceps muscle splits into two tendons at the shoulder proximally. A long one and a short one. The long tendon runs over the top of the humerus bone (upper arm) and attaches to the top of the shoulder blade. A rupture of this tendon is rare in young athletes but more common in older ones.and distal end rupture is common. A rupture of the long head of the biceps is uncommon in competitive and recreational athletes.

4. The biceps muscle The long tendon on the right hand side goes over the top of the humerus. Distal tendon is attached to bicipital tuberosity of radius.

5. Rupture of the long head of the biceps Distal end rupture

6. MRI of bicep This particular case was diagnosed as having a complete rupture of the long head of the left biceps

7. Symptoms A sudden sharp pain at the front of the upper arm. Pain and swelling over the front of the shoulder joint. (long head). Ball like swelling in arm.(distal end). Athlete will be unable to contract the biceps muscle against resistance because of pain (especially in the first couple of days after injury).

8. Diagnosis Examiner will ask athlete to bend the arm and tighten the biceps muscle. Pressure will then be applied to the top of the arm to see if there is any pain. If there is a history of shoulder pain, an MRI or a special X-ray called an arthrogram may be necessary to see if rotator cuff muscle has been torn as well.

9. Treatment Conservative treatment is usually all that is needed for tears in the proximal biceps tendons. (long head) Ice applications keep down the swelling. Nonsteroidal anti-inflammatory medications such as ibuprofen reduce pain.

10. Treatment (continued) You should also rest the muscle, limiting your activity when you feel pain or weakness. To keep the shoulder mobile and strengthen the surrounding muscles, prescribe some flexibility and strengthening exercises. Surgical repair of a complete tendon tear can be done for younger individuals whose work involves heavy labor or lifting.

11. Treatment (continued) Complete tears of the distal biceps tendon require surgery to reattach the tendon to the bone. Range of motion exercises can begin as early as two weeks after surgery, although forceful biceps activity is often restricted for four to six months. Partial tears of the distal biceps tendon may be treated either conservatively or surgically.