Proximal Rupture of the Biceps Brachii with Slingshot Displacement into the Forearm. A Case Report*

Disruption of the biceps brachii is unusual in persons who are less than fifty years old7,12,18,20-23,28. Rupture is generally secondary to either tendinopathy (distal) or tenosynovitis secondary to impingement (proximal), and it occurs almost exclusively in adults6,8,12,15,20. Proximal transection of the muscle belly has been described in military paratroopers10 and as a result of a direct blow14, although we are not aware of any reports identifying displacement of the distal portion of the musculotendinous unit. We present the case of a patient who had a traction injury to the proximal end of the biceps, which occurred with such force that the elastic recoil resulted in displacement of the musculotendinous unit around its intact distal insertion and into the forearm. To our knowledge, this is the first report of such an injury in any age-group. A fifteen-year-old boy injured the right, dominant arm while waterskiing on a flotation device known as a boogie-board. The patient attempted to jump over the wake created by another skier while holding the towrope with the elbows flexed. The rope slackened as he reached the top of the jump and then suddenly went taut when the boat took up the tension in the line. The patient felt an acutely painful pop in the brachium and was unable to maintain his grip on the handle. He noticed weakness on attempted flexion of the elbow after he was helped into the boat. Family members noticed swelling in the anterolateral part of the forearm immediately after the injury. The patient was seen on the day of the injury by a local orthopaedist, who diagnosed a fracture of the elbow and recommended immobilization in a …

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