Nov 21, 2011|
Bruce M. Leslie, M.D. talks with Dr. Glaser about the bicep muscle and injuries that can be avoided.
Transcript - Not for consumer use. Robot overlords only. Will not be accurate.
Miss them a your resume their health and wellness -- with the dodger -- -- your mom and AM six AB WR -- your. -- -- This is -- relatively reserved welcome -- -- little -- -- I think it was succeed WRKO. I hope you all had a great league NL. -- -- And I wanted to welcome doctor Bruce Lesley from new -- orthopedic associates joining us this on the afternoon. We have numerous. Luciano. So we're going to speak about the biceps. Today. Ends. Most of us may think that by -- injuries. Are limited to the athlete. That they're limited to the athletes who maybe using steroids. But it turns out the story is not so. Bruce have you could define. The biceps for us to start in simple terms for all our listeners going to be great. I think most everybody knows -- biceps muscle is it's the major muscle above the elbow. When the Hoboken when muscle contracts it -- the elbow or -- deal. And many people do biceps curls to try and sexy -- the biceps muscle. Takes origin. In the shoulder. But has -- and about as big as your little finger. That inserts on -- called a radius one of the bones just pistol beyond the decrease in your elbow. So when the muscle contracts it pulls on the attendant and venture gobble up. Four. Men. Verses women. In the way that they can injury biceps. Is a difference it's very different. What I you speak -- and I'm sure you were taught to. Is that the biceps tendon. Ruptures only in people are very muscular maybe take steroids and our lifting heavy heavyweights. Female biceps tendon ruptures were almost unheard of and that's where I was trained them -- when you were trying to crack absolutely. What I discovered over the years. Is that what happens is the biceps tendon ruptures and just average people to be quite honest it's a rare person. Who has a biceps structure from steroid use remember when Ted Johnson had his -- sure. And I mean I don't know Ted Johnson I don't know his training program but you and I both remember that a lot of people were saying had something do with steroids. Absolutely doesn't I Don almost 400. -- the biceps tendon repair -- which is a loss and I can count on one hand how many patients have truly taken steroids. It's an average person doing their average thing over and over that just phrase the ten and over time. As I should mentions that. The number of repairs that doctor rose Leslie has done. Amounting to just under 400. Is the most from the country the most nationally. Probably a me it's not something that's. People keep statistics on but when I go to national means we talk to each other about procedures we've done. I'm probably up there we'll give -- an official title then thank you. Tell us a little bit though when me. Young athlete gets to your office. The weekend warrior. And they think in a biceps injury what are those steps you going to take. Well first all you have to remember biceps injuries occur only in certain age groups. So men for instance tip we'll get it when they're 304050. Years of age. Can go to an -- that's the basic range. Women get it around Medicare age group which is most unusual so -- typically see a woman with a -- structure around sixty years image. What happens is if you think of the ten and -- I said the muscle attaches to the ten the the tendon as far as big as your little finger think you'll like rope that's getting frayed over time. So yes there will be the occasional person who -- perhaps we no symptoms whatsoever. And they did something over the weekend. And felt something pop for terror so what that personal complainer and what that personal motives. Is a sudden ripping tearing sound in the front of their elbow. Typically the muscle over -- approximately like a window -- that rolls up because it's no longer attached and you get that -- by looking muscle. Many times within 2448 hour shift some black and blue around the oval -- associate with a sudden. Severe pain and and the pain quiets down in the -- over trucks. The most common though is actually afraid tendon -- quicker rope that's getting frayed. And as the rope phrase it causes symptoms and pain. That patient. We'll have a history of having done something may be where they fired the biceps so the typical story would be for instance somebody carrying a large sheet of plywood. Or maybe the father trying to stop the sled that's going down the hill and they fire the biceps with a child doesn't go out on the street. Or maybe you're walking down a stream and you slip and fall -- up and grab -- -- in your fire in your biceps. Or could be a hockey player as are following through on their slap shot with a strong. With a strong biceps and structure they'll feel little pain not necessarily the ripping. But the key characteristic. Is pain in the front of the album. So Bruce when the patient presents you with pain in the front of the Elmo. Fans. You get a careful history. And a careful examination. How often does the MRI and Tibet. Doesn't that's a great question. At the moment. The MRI is the most definitive test we have to evaluate -- for biceps structure. But I actually did a study where we talk. About 25. MRI scans. From complete chairs and otherwise in other words patients battery operated and so I knew that tendon was completely ruptured. Tendons were they were afraid varying degrees a little bit under 50% a little bit over 50%. And then threw in there about ten normalcy so we had sixty MRI scans 25 complete terrorists 25 partial -- normal. Shuffle them all up and gave them to some really good radiologists. And said. I know what they show you tell me what that show Margaret what's -- accurate the MRI scans. It turns out that with a complete -- attendance completely ruptured holed up like a pop by muscle. The accuracy is -- percent another worst a radiologist got to correct. But to be quite honest you don't really need them I scanned for that it's clinically obvious. On the partial cares where the tan and white rope is going prayed it was only 60% accurate meaning 40% of the time. They missed. That's not terribly accurate for a medical test. Yes it by examination in history. You were able to tell exactly when you were dealing with bright so what you're asking us. How do you make that diagnosis how do you know somebody's tendons getting -- how do you know if they have a partial tear. And the answer really is the examination in the history. And it's the story of somebody having pain in the front of the elbow. Sometimes. You'll have some thickening of the tendon. Yeah after member tendons are we surrounded by chief. She mean like in insulation of sorts and between the insulation attendant is fluid that -- the tendon so the tendon is partially torn. You can imagine how that she's full swell all. And attend and instead of having its normal flat appearance we have been -- Sometimes. If these. Partial terror is a bit more than 50%. The muscles start to migrate up meaning move up a little bit so if you have somebody fire -- biceps and sit in front of them. You'll see one muscle may be a little bit higher may be a -- -- -- the other. Those of things to look for but it's always the history. This is doctor Alon Glazer and you're listening to their health and -- hour on Boston's fox station in 0680 WRKO. To call into doctor Leslie with a question you can call 617. 2666868. Again at 617. 2666868. We have alive operators standing by. Additionally that doctor Leslie's. Medical practice and Newton Wellesley what -- associates. They have a great website. Www. NW always dot com the end -- WWW. -- Newton Wellesley went to -- -- associates. NWA. Dot com. I do love and -- -- speaking about bias of terrorism about complete -- in about partial tears. Ends. I'd -- he was just telling us about a study that he did. Where. Patients were no -- either complete terror or partial terror. What's -- normal. They all memorized. These memorize or read by the radiologist. To see in a partial terror. How accurate is the memorize reliable. And a complete terror. How accurate or reliable. So Bruce after your study. Does that influence the way that you practice. Yes and no. Mean to be honest and you and I are both clinicians were used to treating patients so we roll -- to a great extent on the history in the physical examination. But many times patients want to have something they can hold their hand so you're asking me do life capsule we need an MRI -- no. But then again you're asked me to do is surgery which is relatively big surgery without a confirmatory study. So I will frequently get the MRI scan if the patient wants it but they understand it's not going to change anything then no I do not get it. For treatments. You have a male patient in your office. Somewhere in their thirties forties and fifties as you mentioned that was the most common age range. Or for women. In their sixties. And as they have a biceps there. What is the treatment options for these patients because I know that a lot of patience. -- going to say boy I really don't wanna have surgery if I don't need it but with a biceps is fairly definitive treatment correct. Correct so you have to break it down to what we call complete -- where the biceps is no longer attached that's the dramatic here. That most of your listeners will know somebody who knows somebody who has won or the partial terror -- trade. So you need to have this piece of information. The biceps muscle is probably one of the strongest lectures of the elbow but it's not the only reflects her. So if for instance you have a complete -- -- -- biceps tendon your arm will still work. The muscle B umpire look like Popeye muscle but your arm will still work and you have good biceps deflection strength by that I mean. Flexing the elbow then you -- two and a biceps -- it'll be a little bit weaker but you can work on your muscles to make -- stronger. Which you will really lose is what we call super nation where screwdriver action where you turn your forearm. To the side as if you're twisting a screwdriver. The biceps is actually the strongest super -- in the form so if you have a complete pair of the biceps muscle. You lose 40% of your strength that's been shown in a number of studies. So nowadays. Most people will have the operation done simply because they want to restore that screw driver action that super nice super nation strength. But when you have a patient to that's not important to. They don't care about the cosmetic appearance of muscle there's no reason to fix. And if you -- women number women are the older age group there my favorite because there was a great stories how they do what is different than a man. But you're usually do would Medicare age group women so it's a complete terror in a woman you can see how a sixty -- seven year old woman. May not want to have a fixed. Just some because of the -- However if somebody has a partial terror. We're still touched the guerrilla group that trade and you could have anywhere from 90% attached. To 10% attached. Partial -- are different they cause pain -- cause a chronic geeky pain in the front of the Hubble. The reason why people want the partial -- -- is because they wanna get rid of that pain. For the complete -- If a patient wants to gain back. As much strength as possible. They need to have surgery correct probably a real -- -- get good strength back Louis called by supply option to simply. Bending your arm up so your hand touch your shoulder. That you get good strength back but if you wanna have super nation strength just a screwdriver action that's the twisting action when you your form -- union fixed. When a patient comes to your office ends the tell you. That they wanna give back as much -- that is as they can but that they wanna hold off on surgery for -- now to the go to physical therapy. Again it depends on whether it's a partial or complete. -- -- that way if you have a complete terror as a general rule you wanna get it fixed within the first three weeks of the injury. So with the US a patient know you have a complete terror. You need to see somebody who's taking care of this before within three weeks Y three weeks simply because it's easier to fix it surgically. After three weeks the technique. The way you fix it is different there are more complications the results are not as predictable in terms of restoring strength. So for complete -- three weeks is a good rule. When it's a partial -- there's absolutely no rush. So what I will frequently tell my partial -- patience is that look your attendance freight like a rope that trade that's why you're having the pain. The treatment for partial tear believe it or not this is exactly the same as a complete terror in other words you go win. Trance sector cut the -- and get rid of the freedom and numbers like a -- to trade get rid of the freighter and put some sutures and it and reattach it to borrow. Exact same treatment. So there's no rush to do we know partial -- repair. So if you're busy with your wife may be at home her work for -- it's not that -- just bothering you every now and then. There's no reason to rush into it what's the worse it's gonna happen the worst it's gonna happen is it'll raise some more. Maybe eventually pop and when it pops there's a three week rule him. For patients who do undergoes surgery. For both completes -- in partial -- Is the -- ability of period of time the same rehabilitation is the same. On the rehabilitation changes depending where you are around the country as fixation techniques get better. People are getting back to do we know weight training sooner and sooner so it can range anywhere from about. For. To six weeks to three months before you you're allowed to go back to doing which are doing before but this is a very big muscles -- you can imagine. After even. Six weeks or three months the muscles going to be weak and it really takes and somebody -- well muscled does a lot of sports a number of months. And somebody who's really strong this heavyweight looking for a job. To be honest it probably takes six to nine months to get back to where you work. For the athletes. Who will come to your office. And recognizing you know the population that you very defined which is more common. But for an athlete which sports do you think puts people most susceptible. To a biceps -- Well understands going to be some never. Requires forceful plucked from the biceps so I think it's sports where your firing your biceps against some resistance and you mentioned the hockey player who hockey player two and a slap shot. But -- Mo Vaughn hit a vice -- advice cause baseball player. Pressure those are the torture gonna -- you're not gonna see it's so much and a golfer he -- -- golfer does other things on the side working around the house carrying things. But the golf stroke isn't gonna really do. -- swimmers don't get it volleyball players don't get -- basketball players rarely. But you can get it from other things these athletes may be doing weight training or every day activities. This is doctor -- laser and you listen to the -- the moment sour on Boston's talks Asian. They were succeeding WRKO. To be stuck to Bruce Lesley from -- miles north of -- X. With questions during today's show please call 617. 2666868. Again at 6172666868. And there's a lot of operators standing by. -- so. Ambulances and medical group. Has a great website WWW. Cut and that you always trying to calm me in this and W only dot com and their phone number to reach. Rodney Leisle I -- name. For consultation and -- biceps injury. 6179640024. Million 61796. War 002. Line. Your resume their Barack Obama will Lazare in with the doctor blazer on stadiums -- great WRK okay. And this is doctor -- laser room and you listening and -- -- sour on the balls. -- -- -- -- They succeed WR -- -- -- start to -- mostly from Newton Wellesley or the beat X with questions during -- so please call 617. 2666868. Begin at 6172666868. And there's a live operators standing by. Also. Doctor Leslie is medical group has a great website. WWW. Diet and W always dot com -- and W only dot com. And their phone number to be it's not -- Leslie. For a consultation. For a biceps injury. 6179640024. Again at 6179640024. This is a lesson to all the listeners -- Thirteen. Comparisons in your group correct that's correct in each one has your little -- air and units is biceps among many others hands. With biceps. Injuries. In if we had -- tell. -- patients. Who. On the weekends. Feels they may have torn their -- up from the signs that you're mentions. They may even feel that pop or hear the pop. Should they -- Monday. Well there's no rush to go and emerge from from that I mean certainly kind and most of emergency rooms will diagnose the problem. Former what I said there's a three week window. So if for instance you injured over the weekend and you feel that -- that ripping sound that Terry sounds. If the muscle migrate -- -- rolled -- like -- window -- you get black and blue you can be pretty certain -- device that structure. And if you were to call and see your doctor Monday Tuesday or Wednesday as long as it was addressed -- in the first three weeks. You got a good result that doesn't make a difference whether the first week for the third week. As all this taken care. So the only reason that. But patience is really heroin timber newsroom. -- -- suspected injuries but this unrelenting pain and they need that help otherwise they really should be waiting. To be honest you should not have unrelenting pain it's a sudden pain that should quickly passed. The other reasons to go if you're concerned about the diagnosis you're worried -- something else going on of course you should get a scene right away. But if it fits the description you are talking about it's probably a -- here and does not need Immersion medical treatment. Telus a little bit more no switching gears. Getting into the triceps muscle injuries that you seem with a triceps the triceps is a much rarer injury the triceps as you know. Is the muscle on the back of the arm it's what extends the -- streams the arm out. It's a flatter muscle but also very bigs muscle. Unlike the biceps tendon but it which is about as -- your finger and attaches deep inside the triceps is a relatively flat tendon. Which attaches to the back of the elbow to the would call real work or not. That is rare we torn so in my case where I've done probably more than many people. I've seen four or at least 400 pistol biceps tendon ruptures. I can count on two hands how many triceps I've had to repair so I've probably repaired tent which is a lot. And it -- it's much less common. It is much less commonly a complete care. By that I mean we're completely ruptures. Typically it's a partial -- pulls off a little bit. Those are much harder to diagnose. Those who are well diagnosed -- MRI scan. And that was my next question was the MRI will we know an impartial terror. May not be quite as helpful with the partial biceps -- It is very helpful. With a partial triceps -- Probably. You have to understand and as a doctor knows many times we make assumptions about tasks in terms of their accuracy. And how sensitive they are. The same with a biceps until this Paper was written for -- -- assumed that it did didn't show on the MRI -- you therefore did not have a biceps terror. And we showed that these MRI scans reward accurate 60% of the time 40% of the time you could have a terror in their radiologists would miss it. We really don't know the number for a triceps because there's no comparable study. We just assume that it's more accurate because it's more superficial -- then it's easier to identify and to be quite frank we have. No other study to use. And this over here there'll be hard to do you think you're correct any bowl like the biceps. The diagnosis will be made by the history. In the physical examination you were doing something that fired your triceps forcing your -- to extension and you felt a terror or rip. Or pop and now you feel weaker. Sometimes on examination. If you feel the back of your mobile you'll feel the bone as you work your way up. Especially if you're contracting your triceps you'll feel the muscle and attend the -- is so hard. Firm for structure. If it's a partial terror. You actually feel with the attendance pulled off maybe put your finger total for the titans pulled off. In very. Bad cases are complete -- the person cannot straighten the -- -- -- if you eliminate gravity does not mean. If you bring your arm up to the side so what's up the side of your shoulder and then move your arms so it's moving in Marin with a -- so when you flex it. You bring pitcher Chan and when you extend that you straightened out if your triceps isn't working you cannot straighten out. Switching gears back to -- Simpson injuries. And now getting back into the female population. Where artists -- absolute favorite and their mainly in our sixties are. We don't finds these injuries. For all of our listeners. And especially for our female listeners. Who are in their sixties. And their seventies. What are some of the ways that you've heard. That's women have injured their biceps that we may be listening right now thinking oh my goodness I never even thought there was a possibility. Parts of this is why. Women are my favorite -- men have the same story they were carrying something they were doing some thing they were resisting some thing and they felt that. Chair where they felt pain in women. First of all who ever thinks of your mother or grandmother has getting a biceps structure I mean who does you don't think of them absolutely but they're the ones who do. So these they're the want to have the best stories of my favorite for example is a woman who used to go play slot machines stone and Atlantic City. And she would possibly be poll number one arm bandit movie and she didn't notice issues having pain in the front of the album. Another woman. Better summer house up in now Canada somewhere would be trimming the -- costly using the old tremors and already open them up and close -- constantly doing that. And they're doing something that they do all the times the same with the email biceps these are normal folk. Doing your normal thing it's just who thinks of mother grandmother doing it. Now what's different about the mother and grandmother is their older first of all. Much less common. About a third of the time. You'll actually have what we call palpable mass. In the front of the Hubble without means is if you feel the front of the elbow you'll actually feels that there's a little water balloon there. And the water balloon number what I set as the tennis -- advice she's and it's lubricate it with fluid. It's almost like a gang when most people go to gangly in his a gang lands like I think like a bicycle tire with a -- inner tube. Feel a whole was hired -- to bulges out. If you -- all weakness in the -- around the biceps tendon. This food filled sac bulges out so a third of the time at least. You'll see you'll feel a mass there and sometimes before a female biceps terrorists were recognized. These women were thought to act actually of tumors or cancers and they were worked out that way. And there's a number of case reports in the literature where somebody did surgery. Thinking they were gonna find something bad and go oh my god this afraid tendon who have. They're very very different now what's also different about women is that most of the time -- partial tears. Whereas with the men most of the time they're going to be complete -- And remember what I said. Partial tears cause pain so when you're asking before why would your mother grandmother sixty years of age or older. Have the surgery is because of chronic unremitting pain. And you can try all sorts of things to relieve this pain you can try therapy can try medications. But the truth of the matter is. There's never been reported series but I mean -- somebody actually studied this. And saw a hundred patients until I treated in this way and I treat him out when somebody did well on somebody to -- -- there's never been that series I'm partial shares. There's anecdotal evidence somebody says they get better they don't get better but no one really knows. The slot machine injury. They were telling us about. One way to reminiscent of that pain of courses you're -- when -- try to -- triple seven -- I'm actually looking -- or who the new casino development and Massachusetts. I'm -- increased number of women once. -- of structures there -- So. You mentioned about physical therapy. And about medications and there's been. No study really that's really going to be. Crystal clear on what we should advise patience but have you do the female patient in their sixties and seventies. -- They are going to need. Some pain relief while they're deciding. Am I going to get surgery in my it is going to try to live with the pain but innocent you -- advising these patients. So what we usually do. It is will start the Mon not destroyed or anti inflammatory medications songs it's okay. With -- primary care physicians as many of these patients are taking other medications and their side effects. So it's always crucial that the doctor or the patient talk to the primary care physician and make sure there were not adding a medication can be dangerous. But usually use -- -- destroyed on anti inflammatory medication you can use aspirin tile -- is not a monster what do what can also be used. And we'll try therapy because remember what I said what's you have to say what's the worst possible outcome the worst possible outcome is the tendon phrase complete week. And like the rope that's -- trade eventually terrorists and pops. So the worst is you're gonna end up doing the surgery sometime down the road. It may just be that there are times that a father -- so maybe one that woman using the slot machine to -- her when she's not it's not. So you do activity modification when there's a volume was trying to avoid that if that makes it better you can avoid surgery. There's nothing wrong -- doing therapy but nothing's been shown to prove that there -- necessarily works. This is doctor -- Glazer and you listen to the health and -- our own Boston's talks -- They -- 680. WR TL and our guest today is doctor Bruce Lesley from Newton Wellesley orthopedic associates. And was speaking about. -- of -- is a little bit about triceps errors which are much less common. And specifically know we've been getting into. Biceps. Treatments. Doctor Leslie mentioned about not destroy real anti inflammatory medications. To -- view this -- and we've done some other shows. You medications. Such as Advil Motrin Ibuprofen. Should not be taken lightly. You need to discuss that with your health care provider. They may be a reason you cannot take these medications. If you're able to take his medications. You wanna take them with food and please remember that these 600 milligram prescription strength and Ibuprofen. Is a little different than -- really over the counter 200 milligram Ibuprofen is the preparations a little bit different. The 600 milligram prescription strength is going to be a little bit stronger for you. And it's it's different even though was -- 600 milligrams of both scenarios. Please keep that in mind and prescription strength obviously will require a prescription. As worth talking about by Simpson -- and a lot of this is. Hard to visualize as doctor Leslie and I are speaking about. The anatomy. And of course we have a medical background and we worked our listeners to understand this. As well as they can. One way to help you along with us. Is on the website and you will see what the pinnacle associates again that's WWW. Dot NW always dot com. Doctor Leslie let's put together in PowerPoint presentation. On how that series repaired. And it's a great website. This'll go through. Exactly the steps involved. In that -- repair. And it's really geared for the patients. In an alleged to be afraid to go on meet the website doctor Leslie is not assured me that it's not too graphic. And that to be very helpful for you and I really encouraging. To go on the web site. And look at this. Even if you hopefully. Never have the injury. Most likely know someone who has had the injury. -- It would just be very interesting for you probably to go on and look at these steps so when you go to the website you're gonna go on the patient education. Under patient education he's going to be led to the former noble. In under the Foreman noble you'll follow the steps and you'll see exactly. How the biceps. Is repaired in the setting of a terror. Getting back to. Females again. And we've heard some of the more unique ways. That's. The female patients. Can have the advice of stare. What would you say that the Leslie. For a female patient. Whose older. After knee surgery. And they -- that same range. First time for recovery. Yes but it's not as important to them. Again think about your mother your grandmother they're not going to be doing big weightlifting and are going to be caring for -- sheets of plywood they're not -- bench pressing. Really what they wanna do is get back to their independent ways. So what happens is within about a month or so they should be moving your there are fairly well. Carrying white loads nothing terribly heavy. -- three months they'll be doing anything they wanna do so. The goal is different the goal for your mother grandmother Mary Carey group patient -- to get rid of the pain get the tendon reattached and healed but get rid of the pain. After an operation the pain is almost always gone within the first -- well within the first week there's always pain with the surgery -- the first week please call. So. And a ten healed and do better if you think about it their arms are smaller than not that big mosque your arm. So with a thinner arm there's going to be US surgery with a less surgery UB US trauma. Let's trauma less swelling. They generally do much better -- and recover much faster. Would you say that's for all the patients who present to your office. Of men and women. Which population. Waits longer to seek medical attention when these -- it's always the partial share a complete terrorist dramatic when you have a complete terror. The muscle were tracks as you and I discussed. There's that sudden pain which people this will described as -- been carrying I've heard people describe it as electric girl lighten. -- People no -- -- complete -- it's rare they don't it's the partial terrorists that people don't know what they have meant to be quite frank. Many. Physicians. Or value leaders don't really know. Mean it's you don't see if you were to look in the literature. You're not conceal a lot of articles on partial -- is becoming more and more evident now as some of us do more and more decent start right -- up. But think back when you when I trained we never heard of a partial terror. So you'd have people with pain in the front of the elbow. And you treat them symptomatic -- pat them on the back peace of mind sampling and I'm from medications and therapy. But in reality we didn't know what they have. They're the ones that are the latest to come I mean I just for instance operating on somebody. Who he's retiring this year -- operate on -- other side. For five years ago and he had pain in the opposite arm. And he knew it was there was able to do his job but he just ignored but it got to the point -- said. What's going on here and payment that I -- you have the same thing on the other side. Operated -- his pain is gone more than a week. Missed a partial tear said people don't get treated right -- But the baseball player in the hockey player. Who has a partial to there being another completes there was of course there was more obvious. But for the partial terror in the hockey player with a baseball player. And this is not picked up by the trainer and they continue to play. We already know that you know with a partial tear that eventually you'll get more and more freedom the tendon. And eventually can become that complete terror. But my question where I'm going is. For that athlete. How important is it that the trainers shut them down if they suspect that there's a partial tear of the biceps. Well this is actually an easy answer in this nobody's being harmed. So remember the treatment for partial shares the same whether it's 10% torn. 99.9. Percent torn -- exact same treatment which is the operation. To transacted -- it remove the damaged tissue and reattach it. So you don't do any harm to the athlete. By waiting. So if you consciously weight because you're trying to get the athlete through the season for maybe you're. Unconsciously. Waiting to you don't make the diagnosis it doesn't harm the athletes. I think the key point is if you have persistent pain in the front of the elbow. It's an -- cramping pain in anybody's had tendon pain knows exactly what I'm talking about it's a sore -- cramping pain. And it seems to be bothering you when your firing your biceps may be doing bench presses biceps curls that that's slap shot. Swinging the about all the way through making contact. You should be thinking I wonder -- a partial terror. And then my advice would be see somebody who's seen a lot of this and have them evaluated. And then talk about your treatment options. We're all of our listeners as were. Heading toward the end of the show. If you -- of three pieces of advice. That are the most crucial. For the patient. Who has suffered the complete. Biceps terror widows three -- information. The first would be to know what. A complete just a biceps tendon terror looks like. Typically what's gonna happen is you're gonna have sudden pain. As the attendant rips off the ball I don't mean to sound dramatic there to muscle retractable roll up like a window shade. Three you who frequently. The ball black and blue on the inside of the arm near the -- those -- the three physical findings. For complete care and if you have that or think you have that. Then make sure your evaluated by somebody who can confirm that and tell you what to do next because if you want to have it repaired. You have a three week window to get it repaired. Don't get me wrong. I'm I can repair it after three weeks other doctors can repaired after three weeks. But it's easier to do in the first three weeks and you always want to have surgery it's easy not complex. For the partial to -- Same question. Three pieces of advice for our listeners the key thing with a partial tear is to know that there's no surgical urgency to it. In other words you're not harming yourself by not having it repaired right away. Remember what I said the -- like a spectrum of a role that's getting frayed. The worst case scenario. Visual -- again you'll terror couple more farmers and truly worse case scenario give a complete terror and and we -- it falls in the what we just talked about. So there's the first key piece of information no rush. Don't panic don't worry no rush. To. If you're having pain in the front of the album that streaky cramping pain we constantly refer to. Pain that occurs when you're firing your biceps. Usually thinking I have a partial terror. And then three. How do you make the diagnosis. Sees somebody who's a value in this. So they can give you good advice. Sometimes an MRI scan will help but remember we -- you and I talked about this -- MRI -- not always accurate. So the key thing is to see somebody who is of value and this before who couldn't look you in the eye and say look I think you have a partial tear here's why. Don't worry about it don't panic there's no rush. And that more often than not you're not going need to go to the emergency room for a biceps terror. Actually from our discussions you you really should not need to go. But that's provided that you know that the injury really is a biceps terror so our advice would be call. Beyond called doctor on the weekend. Describe the injury describe the biceps looks like. And they'll be able to tell most likely over the phone or your description the say boy it sure sounds like a complete biceps -- You don't want to wait very long but come into the office on Monday Tuesday Wednesday they should be find excellent just. One other. Question that I have for. The older population. -- grandparents. How often do you hear. That. The BA biceps injury published in the grandchild. Have yet to hear that. But I can easily imagine if somebody's constant who -- the grandchild. It's no different than doing -- repetitive injury with a biceps but. Haven't heard yet -- a lot of grandparents all there and even more grandchildren so I'm going to say it's probably very very rare. All right that's that's great easier because I my parents babysit our little Isabella. -- seventeen months old she doesn't -- much more than a sixteen -- so I. I think we're safe and the other good reason for me to. To notices of my mom starts telling me that our armor is turning there I will tell it that doctor Leslie said. This is extremely unlikely. -- -- them stare. You go ahead and they continue babysitting for Allen hope and help -- keep helping out Allen and babysitting yes and I know they're listening. This is doctor -- Glazer and you're listening to the -- the moment sour on am succeeding. WR TO. Our guest today has been doctor Bruce Lesley from Newton Wellesley orthopedic associates. Doctor Leslie and I have been speaking about -- of stairs. For the main part of the show a little bit about tries upstairs. Stands. Please go onto their website at www. NW always dot com. Go on to patient education. Go down to the forearm and -- section and you'll see a great PowerPoint presentation. On how the tendon. Is repaired. -- -- -- are there other. Pleases in that patient education. Area where patients can go on and actually visualize other procedures for your group. There are one or two of the biceps I've sort of because of my interest have developed that but it's something that's constantly changing and yes they will we'll find other demonstrations. That sounds great that sounds great so again. Www. NW -- dot com. The phone number for a -- it was a orthopedic associates. We -- doctor Leslie or any of his other 12 associates. Tomorrow morning. Monday morning at 617. 9640024. Again 6179640024. Please remember. That -- biceps terror. Is not a medical emergency. But do not delay in being seen. As doctor Leslie was mentioning. To repair. Surgically. It completes here. It's ideal. To be seen within the first three weeks. You could slow surgery after that time period but these -- the surgery. Will be much easier to be done earlier so. If you're unfortunate to have when these -- -- injuries. Do not only calling. This is doctor Alon Glazer of human listings and help them well this hour on idioms of -- WRKO I mean I don't that you're happy healthy -- -- week. I hope that you have a wonderful Thanksgiving holiday coming up my -- and thanks for listening and I.