Case of the Week # 2

jcubos — Tue, 23 Aug 2011 00:38:55 +0000

Each week, I will be presenting a “case of the week” where you, the readers, are invited to put on your thinking caps and participate. The format will be the posting of a “history” and “physical” for two days with a poll whereby you are asked for your diagnosis. You are also asked to provide your treatment plan in the comments section. 48 hours later, the actual diagnosis will be provided with a short treatment plan for said patient. Each case will be hypothetical and will in no way reflect any true patient.

History

Male, 41 years of age
Crossfit enthusiast
Former competitive bodybuilder
Acute onset of pain (sharp) located along anterolateral aspect of the right elbow 23 days ago
Reports onset from slipping on the 8th repetition of a kipping pull-up
Prior smoker of 12 years, 2 year history of performance enhancement substance use

Physical Examination

Neurological examination (sensory, motor, DTR) within normal limits
Minimal ecchymosis visible surrounding right elbow
Active and Passive ROM full and pain free
Pain with combined resisted elbow supination and flexion at 0 degrees
Palpable distal bicep tendon
Localized tenderness in the region of the anticubital fossa

Radiographic Findings

Plain x-ray: “normal elbow”

Diagnosis

View This Poll

Treatment Plan

Please state your answer in the “comments section” and provide a recommended plan of management

**Concluding Diagnosis**

Before I state the final diagnosis, I’d like to thank Greg Dea for his comment below. While I agree that very many tears do occur at the musculotendinous junction, it is still very possible for a tendon to tear. It is also possible for a tendon to avulse off its body attachment with no bony avulsion. That said, the “best practice” answer was “Partial Tear – Distal Biceps tendon”. Let me explain why.

Males between the ages of 40 and 60 are epidemiologically the most prone to suffering distal biceps injuries. The prior history of smoking and performance enhancement drug (presumably some form of steroid) also predisposes this individual to weaker tissues. The lack of substantial ecchymosis and the palpability (is that a word) of the distal biceps tendon – the “hook test” – also rules out the possibility of a full distal biceps tendon rupture. Finally, the mechanism of injury, likely an eccentric contraction, rules out the possibility of a medial or lateral epicondylar injury.

With respect to the plan of management, one of the top priorities would be to request a diagnostic ultrasound for confirmation. Should a full rupture be suspected, urgent orthopaedic referral is mandatory. Following this, normal protocol for partial tears apply.

If you would like more information of Distal Biceps Tendon Ruptures, make sure you check out this clinical assessment protocol.

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I hope you enjoyed this exercise and make sure you check back next week for C.O.W. #3!

Case of the Week #1 What's your diagnosis?...

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Olympic Lifting is a Privilege

jcubos — Fri, 05 Feb 2010 20:29:27 +0000

NOT A RIGHT! Because the only thing you’re entitled to is sustaining an injury.

As per the short description provided by the International Weightlifting Federation,

“(Olympic) weightlifting is a perfect demonstration of physical strength, technical skill and concentration combined. Lifters compete individually in a competition that requires physical and mental preparedness and eventually tactical skills.”

Stated again,

“(Olympic) weightlifting is a perfect demonstration of physical strength, technical skill and concentration combined. Lifters compete individually in a competition that requires physical and mental preparedness and eventually tactical skills.”

Therefore, to my friends in the “fitness” industry that utilize these skills to “enhance” general fitness and induce fatigue, I remind you that

Olympic lifting is a privilege and not a right!

Click here for a good read on AmpedTraining.com on “Functional Cross Training vs. Specific Training“

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Case of the Week # 2

Olympic Lifting is a Privilege