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Injuries and Medical Advice

Biceps: Partial Dislocation

I have had a subluxation (partial dislocation) of the biceps tendon manually relocated, but it doesn't stay there. The original injury occurred when performing a mantel. It's been two months now, but no healing progress.

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I have had a subluxation (partial dislocation) of the biceps tendon manually relocated, but it doesn’t stay there. The original injury occurred when performing a mantel. It’s been two months now, but no healing progress. No problem with full range of motion either; I’m just aware that subtle movements can lead to discomfort, and that there’s something out of whack. What type of professional should I see for a condition like this, or should I start a weights regime to strengthen the rotator cuff?

Steve Kelly
Adelaide, Australia

Man’s second-most-beloved muscle must be the biceps. Though both are graded on the Man-Up Scale for their size, size does not translate to one-arm pull ups. The main role of the biceps is to turn your forearm so that your palm faces up when your elbow is flexed. It is also a major contributor to shoulder stability, and should be considered the fifth rotator-cuff muscle. The understated king of elbow flexion is the brachialis muscle.

The tendon of the long head of the bicep (there are two heads, hence the name), from the muscle rising to the shoulder, sits in a shallow runnel known as the bicipital groove. Holding the tendon within the groove is the bicipital retinaculum (transverse ligament). When this breaks, the tendon flicks in and out, depending on load.

The most common traumatic injury to the bicep is to rupture the long-head tendon close to where it inserts at the shoulder. The next is to tear it at the insertion, which may damage some of the shoulder cartilage. If you have generated enough force to tear the bicipital retinaculum I would be curious about what else you have damaged along the way.

Ostensibly a straightforward diagnosis, the shoulder is a living, breathing subterfuge, a master of treacherous duplicity. On top of that, if it is truly subluxating, your shoulder is likely to be in anatomical disarray.

I am assuming that your diagnosis has been confirmed with an ultrasound or MRI, and not by the hypochondriacs’ wet-dream-come-true, the Internet. Get down to the radiology department.

You could strengthen your rotator cuff to the point of bench-pressing a Mini Cooper and it would not help, though if you see a physical therapist there is a 90 percent chance he would prescribe just that. Conservative medicine, from exercise prescription to masturbation, will fail you. Rest will allow the pain to settle, but the ligament is under such load that repair is virtually impossible.

Given the diagnosis of traumatic subluxation, your only option, other than doing nothing, is the scalpel. If you are the sedentary type, nothing is usually the done thing and it will tend to settle down. You are a climber, however. If your surgeon suggests your retirement, try one more sportingly inclined.

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