Blunt rupture of the biceps brachii muscle - The "parachute injury" in a wake surfer - A case report

Abstract

Case: A 40-year-old man fell while wake surfing and his left arm got tangled in the rope. This caused a closed complete rupture of the M. biceps brachii. A primary muscle suture led to unrestricted function and excellent patient satisfaction after two years.

Conclusions: The mentioned muscle rupture is a rare injury mainly described for paratroopers. As it has also been described for wakeboarding, this is the first description in wake surfing. Whereas in wakeboarding mainly experts are at risk during jumps, in wake surfing beginners are in danger and must be advised accordingly. Generally, the muscle suture leads to excellent function in these patients.

Keywords: Biceps brachii rupture; Closed muscle rupture; Muscle suture; Parachute injury; Wakesurfing.

Fig. 1

Shows the patient while wakesurfing shortly before the trauma. The used rope is too long and he tries to get into the powerful steep part of the wave by pulling himself closer to the boat. The remaining rope is in the water and puts his arm and leg at risk during the fall. As an important safety rule for this sport: the rope must only be hold at its very end on the handle. If this is too long to get into the wave, the rope must be shortened at the attachment to the boat.

Fig. 2

Shows clinical images preoperatively and at the 2-year follow-up. 3a shows the biceps brachi muscle lying completely in the forearm fascia. 3b and c show the clinical result after 2 years. A dent in the area of the rupture and superficial burn scars are visible.

Fig. 3

3a) Preoperative TIRM coronal image with gap between biceps muscle and distal ruptured part 3b) Preoperative TIRM sagittal image (suboptimal fat suppression posterior) with gap in distal biceps muscle after complete rupture and cubital hematoma. 3c,d) Postoperative T1 and TIRM coronal images showing the continuity of the biceps muscle and small susceptibility artefacts from the muscle suture. No fatty muscle degeneration in biceps brachii muscle (Goutallier grade 0).

Fig. 4

Shows the intraoperative course. Careful preparation allowed mobilization of the distal stump and 4a shows the undamaged nerve innervation of the distal muscle stump. 4b shows complete rupture of both muscle bellies. 4c shows the arrangement of the prepared sutures. 4d shows the unproblematic adaptation of the proximal and distal muscle stump in 90 degree flexion position of the elbow.