Disclosures: Brendan L. McNeish, MD: No financial relationships or conflicts of interest

Case Description: Intrasubstance biceps tears are rare and have been described almost exclusively in young military members from paratrooping accidents. Diagnosis of an intrasubstance tear is with difficult with physical exam alone and early recognition is critical as large intrasubstance tears treated conservatively have a poor functional return. In our case, we present a unique demographic and mechanism of injury with a 53-year-old martial artist who after sparring developed acute bicipital pain which didn’t improve with initial conservative management. High frequency musculoskeletal ultrasound demonstrated a partial intrasubstance biceps tear leading continued conservative management and eventual return to sparring of the patient.

Setting: Tertiary Medical Center

Patient: 53-year-old male developed acute right arm pain after his final bout of martial arts sparring which did not improve after 8 weeks of conservative management. Assessment/

Results: Based upon the ultrasound findings, the patient continued conservative management, began a gentle strength training protocol and was mostly pain free. After 3 months post injury, the patient was able to return to usual activities including sparing.

Discussion: This is a unique case as both the demographic and mechanism of injury differ from what has been previously reported and it highlights the use of ultrasound in the diagnosis of intrasubstance biceps tears.

Conclusion: Musculoskeletal ultrasound or MRI are critical for accurate diagnosis of biceps tears. Sonopalpation and dynamic provocative maneuvers may give ultrasound an advantage in diagnosing intrasubstance biceps tears and guiding appropriate clinical management.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/ultrasound-imaging-of-an-intrasubstance-distal-biceps-tear-in-a-martial-artist-a-case-report/