- Tears of the conjoint tendon of the short head of the biceps (SHB) brachii and the coracobrachialis origin on the coracoid are very rare injuries
- This case report describes a 41-year-old man who presented seven weeks after suffering a complete tear of the coracobrachialis muscle in his left arm while wakeboarding
- Delayed treatment of a conjoint tendon rupture has not been described previously
- The rupture was repaired using allograft tendon reconstruction
- At his three-year follow-up visit, the patient had full strength and range of motion in his left arm
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Ruptures of the short head of the biceps (SHB) brachii and of the coracobrachialis are exceedingly rare. In the Journal of Shoulder and Elbow Surgery, Jon J.P. Warner, MD, chief of the Shoulder Service, and Neal C. Chen, MD, chief of the Hand & Arm Center, both in the Massachusetts General Hospital Department of Orthopaedic Surgery, and colleagues describe how they managed a case with a delayed presentation of a complete rupture of both the SHB brachii and the coracobrachialis tendon.
Introduction to the Case
A 41-year-old healthy man was injured while wakeboarding. The antecubital fossa of his left arm became trapped in the rope and tow bar, and it absorbed the traction associated with his high-speed fall. At his initial presentation to Mass General, he reported a subjective shoulder value (SSV) of 10% (he estimated his function was 10% of normal).
Physical examination was notable for fullness in the anterior aspect of the shoulder and tenderness distal to the coracoid. Shoulder MRI showed a complete tear of the myotendinous junction of the SHB, with approximately 12 cm of distal muscle retraction. The coracobrachialis muscle was also involved, consistent with a tear at the level of the conjoint tendon.
Surgical repair was performed using a semitendinosus allograft woven into the proximal and distal stumps.
Seven months after surgery, the patient reported:
- American Shoulder and Elbow Surgeons shoulder function score: 91.66
- SSV: 85%
- Visual analog pain scale: 0 to 1 depending on activity level
- QuickDash score (short version of the Disabilities of the Arm, Shoulder and Hand questionnaire): 6.8
- Participation in usual sports (golf and mountain biking): "somewhat difficult"
36 months after surgery, the patient's scores were still similar. However, his only activity limitation was self-imposed avoidance of pull-ups and push-ups, and he had full strength and range of motion in his left arm.
Guidance for Physicians
When patients present with injuries involving traction, such as water sports that use tow lines, parachuting or gymnastics, physicians should be aware of these rare injuries of the conjoint tendon. In cases where acute repair cannot be performed, delayed repair is a viable option.
Learn more about the Hand & Arm Center at Mass General
Refer a patient to the Hand & Arm Center at Mass General