PMC6588132_01
Clinical photograph of the popeye deformity and midsubstance defect of a patient with a closed biceps muscle injury.
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F1
On physical examination, the patient had swelling and tenderness to palpation over the mid aspect of the left humerus, and an obvious defect was noted with an associated popeye deformity, ecchymosis was present distally though not at the rupture site (Fig. 1).
(a-c) Young adult male with a closed long head biceps muscle belly rupture. LB: Long head Biceps muscle belly, SB: Short head Biceps muscle belly, Br: Brachialis, Tr: Triceps, Asterisk (*): Site of hematoma.
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F2
MRI revealed the following: (a)Sagittal short TI inversion recovery (STIR) image of the injured arm demonstrating the long head muscle belly rupture with an intact short head and partially ruptured brachialis,(b)coronal STIR image centered over the distal anterior upper arm demonstrating complete rupture of the long head biceps muscle belly with a 9 cm gap and intervening hematoma, and (c)axial T2 fat suppression image of the midshaft humerus at the level of the biceps rupture demonstrating an intact short head biceps muscle belly, partially ruptured brachialis and hematoma within the biceps compartment(Fig. 2).
Intraoperative image demonstrating the ruptured long head biceps muscle belly.
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F3
Subcutaneous edema was encountered immediately; the biceps fascia was incised, and the biceps brachii was noted to be transected with preservation of the short head deep fibers (Fig. 3).
(a). Intraoperative image demonstrating placement of the modified Mason-Allen stitches,(b)Intraoperative image demonstrating apposition of the biceps muscle belly while placing traction on the Mason-Allen suture ends.
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F4
The deep internal muscle stitches were closed primarily followed by the superficial stitches (Fig. 4).
Intraoperative image after augmentation of the repair with human dermal collagen matrix.
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F5
To augment the strength of repair, a human dermal collagen matrix was placed over the repair anteromedially (Fig.5).
1-year post-operative images of the contralateral unaffected arm (a) and the affected arm (b) demonstrating no residual popeye deformity and overall similar muscular contour.
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F6
A small divot was noted at the repair site but was acceptable cosmetically to the patient and similar to the contralateral arm (Fig. 6).
6 yearsmagnetic resonance imaging obtained of the affected arm, sagittal (a) and coronal (b) T1 weighted images demonstrate reconstitution of the biceps brachii muscle belly. D: Deltoid, B: Biceps Muscle Belly, Br: Brachialis, Tr: Triceps.
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F7
A follow-up MRI at this time demonstrated reconstitution of the biceps brachii muscle belly with minimal residual intrasubstance scarring (Fig. 7).