Isolated rupture of the brachialis muscleDocument Transcript
ISOLATED RUPTURE OF THE BRACHIALIS MUSCLEDR.HAFIZ-UR-REHMAN, M.S.(ORTHOPAEDICS SURGERY)A/P.GHULAM MUSTAFA, Professor.M.A.QURAISHI, Department of Orthopaedics Surgery Unit-I Dow University of Health Sciences/ Civil Hospital Baba -e-Urdu Road KARACCHI-PAKISTAN. The brachialis muscle is rarely seen with isolated tear that has not been welldocumented. A most common traumatic muscular injury in the upper arm is rupture of thebiceps brachii; 2,4, We report the case of a young patient with h/o stab wound injury rightupper arm who had an isolated tear of the brachialis muscle that was treatedconservatively, only skin closure was done with silk. After 4 months had a return to fullfunction with full range of movements.Case Report A twenty four years old right-hand-dominant young machinist presented withhistory of trauma as alleged assault with knife stab injury, bleeding wound anterio medialaspect of left upper arm three inches superior to elbow joint, margins of the wound weresharp cutting 2.5cm x 2 mm deep to muscles. In wound management, after thoroughirrigation only skin closure was done with silk. Sutures removed on eleventh day. On presentation patient c/o pain, tiredness on working and numbness of the rightupper extremity. On examination the patient reported no erythema or tenderness and muscles powerof grade 4. Active passive movements were pain free with full range of motion. The skinscar was slightly puckered, adherent to underling soft tissue. There was firm, mobile intransverse plane mass measuring 0.5X 3 cm on the aneriomedial side of the distal aspectof the arm. Neurovascular examination revealed normal. No sensory deficits were noted;motor examination showed strength of 4 of 5 throughout, excess for flexion andsupination of the elbow, which were rated 4. The remainder of the physical examinationrevealed normal findings, Plain radiographs of the right elbow revealed no abnormalities, and the soft-tissue swelling. A magnetic resonance image, made without contrast medium,demonstrated a linear defect (ventral to dorsal) in the distal brachialis muscle withdecreased signal on T1 and T2 weighted images. A diagnosis of a distal brachialis muscletear was made. Nerve conduction revealed nerves intact and showed normal conduction. Serial clinical follow-up examinations were performed. Over the next fourweeks, the mass became less tender but caused an occasional burning sensation. The sizeof the mass was unchanged, and no warmth or erythema was noted. The findings onmotor examination were 4 of 5 throughout.
Six weeks after the injury, magnetic resonance imaging revealed increasedsignal within, and thickening of, the distal brachialis muscle. The plane of cleavage andthe retracted muscle fibers were consistent with a partial rupture of the brachialis muscle. Eight months after the initial presentation, the mass was smaller and non-tenderand the findings on physical examination were otherwise normal.Discussion Isolated rupture of the brachialis muscle appears to be a rare injury that has notbeen well documented. The current case (resident of Sher Shah, Karachi) involved apartial distal brachialis tear that responded to nonoperative treatment. Muscle injuries arecommon and can usually be diagnosed on the basis of the medical history and thephysical examination. On examination, localized tenderness and pain with muscleactivation are usually present. Our patient had a muscle tear just proximal to themusculotendinous junction that presented as a recommended only when a diagnosiscannot be made on the basis of the history and the physical examination3. Magneticresonance imaging can demonstrate both acute and chronic muscle tears. T1-weightedimages may show disruption of the normal architecture of the muscle belly or thetendinous junction. These areas of abnormal signal can have a varied appearance rangingfrom linear to more mass-like4.Referenc1-De Smet AA, Fisher DR. Magnetic resonance imaging of muscle tears, Skeletal Radiol.1990;19;283-6.2-Le Huec JC, Zipoll B, Chauveaux D, Le Robeller A. Distal rupture of the tendon ofbiceps brachii, Evaluation by MRI and the results of repair, J Bone Joint Surg Br 1996;78; 767-70.3-Noonan TJ, Garrett, Muscle strain injury; Diagnosis and Treatment. J Am Acad Orthop Surg, Keene JS,Magnetic resonance imaging of muscle tears, Skeletal Radiol. 1990; 19; 283-6.4-Seller JG 3rd, Parker LM, Chamberland PD. The distal biceps tendon.two potentialmechanisms involved in its rupture; arterial supply and mechanical impingement. JShoul. 1999; 7; 262AUTHOR:- Dr.Hafiz-ur-Rehman M.S.(Orthopaedics Surgery)Cell:0301-2575144 Phone Residence +92-021-9216055E.mail: firstname.lastname@example.org / email@example.comMail address:- Room no.14 Second Floor Taj Medical ComplexM.A.Jinnah Road Karachi, Pakistan.