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BICEPS INJURIES In some ways, the biceps is one of the best-known muscles in the human body. Even for people who know next to nothing about muscular anatomy, this structure is easy to locate and engage. Bulging biceps are universally recognized as a symbol of strength. (Just think of a typical bodybuilding stance.) But it can sometimes be challenging to identify biceps injuries and differentiate them from other injuries in the shoulder, elbow, and forearm area. The biceps muscle helps to flex the elbow and supinate the forearm. You use this structure whenever you lift your massage table or use a screwdriver. (The image of the biceps as being particularly strong is misleading, since the real power in elbow flexion comes from the brachialis muscle, located beneath the biceps.) While most muscles cross over only one joint, the biceps crosses over two: the elbow and the shoulder. As its name suggests, this muscle has two parts, or heads; the lower attachment begins at a common tendon just inferior to the elbow at the top of the forearm on the radial tuberosity. The short head has its own tendon, which attaches just above the axila onto the coracoid process. The tendon of the long head dives through the center of the shoulder joint and attaches toward the back of the joint, deep beneath the surface. The biceps muscle-tendon unit can be injured in five distinct places. Pain felt at the shoulder or in the upper arm suggests an injury to the muscle belly, the musculotendinous junction, or (most commonly) the body of the upper tendon above the muscle belly. When the pain is felt near the elbow, it is likely that either the distal attachment or the lower tendon near the crease in the elbow has been injured. The location of the pain can be misleading; depending on where the pain is felt, biceps injuries may be mistaken for injuries to the shoulder joint, deltoid muscle, triceps muscle, or elbow. Conversely, injuries to other structures may refer pain to the upper arm and be mistaken for biceps injuries. This commonly happens with injuries to rotator cuff tendons, especially the subscapularis tendon. HOW AND WHY THESE INJURIES OCCUR Biceps injuries often result from some form of lifting—whether it's weight training as part of an exercise program or moving heavy objects in the course of one's job. They're common in people who have decided to be their own movers, not realizing how heavy their furniture is. These injuries typically occur when a person pushes too far when fatigued or starts to drop something heavy (such as one end of a piano) and then reaches out to catch it. In the days and weeks following a biceps strain, the person may start to notice pain with certain daily activities. For right-handed individuals, closing jars tightly or tightening a screw might cause pain; those who are left-handed would instead feel pain when opening jars and loosening screws. Sometimes the short head of the biceps ruptures completely and the muscle rolls up on itself, causing a lump to appear. This can happen to anyone, but generally affects people over 60. While the rolled-up muscle doesn't look attractive, it causes no actual harm. Very little strength is lost and no treatment is necessary. INJURY VERIFICATION Before beginning treatment, it's crucial to use assessment tests and palpation to determine where the injury is located. Injuries near the elbow, either in the lower tendon or at the lower attachment to the forearm, are relatively easy to identify. Since they cause no referred pain, the location of the pain tells you the location of the injury. Injuries at the upper attachment, in the muscle belly, or in the tendon body near the base of the deltoid muscle can be harder to pinpoint; a severe strain at any of these locations can refer pain all the way down to the wrist or to the posterior portion of the upper arm. visit massageandbodywork.com to access your digital magazine 105