What is this injury??

[Peter Sustr]

Hey guys,

just got back from a camping trip and the below image is of my arm after the trip. Is this a ripped muscle?? What is the treatment?

Any help for this uninsured hiker would be great.

[Anonymous]

Peter,

What were you doing when this happened to you?

[Peter Sustr]

I got his injury while coming down some slick rock and my feet slipped from under me and I ended up sliding. I stopped myself by grabbing a shrub with my right arm. Could have been ugly other wise.

Any thoughts??

[Sean Walashek]

I'm not a doctor, just a wfr. Good bruise/strain. Unprofessional perscription of some ibuprofen, rest, elevate, ice, compress test for mobility. Scale of 1-10 for pain? Caused by the fall or being yanked by your weight on the slip? Can you move it, is there a marked increase in pain when you do (as in OUCH!!!), whats your heart rate/breathing like normal? How old is the photo 2 days? Can you move all your fingers? If you push on a fingernail on the injured hand does blood return to it quickly? Monitor for hypovolemic shock the real danger (caused by fluid loss from internal bleeding) but on your arm and a couple days after the fact don't think a big issue. Breath easy, should improve with RICE and time (if there aren't any flags above)

[Sean Walashek]

I don't think you have to worry (again not a doctor). Topical arnica gels could ease discomfort. If it really hurts get it checked out, serious pain is caused by a serious problem. I don't know you but if you can take a picture of it and write about it you are most likely in the clear. Ouch though, you could rig a simple sling and swatch for it to keep it in a position of comfort.
Check this video for instructions, add more padding under the places that it pulls on your neck, then just tie something around you to keep it tight against your body, you don't need the pin or special knots, just keep it tight, but not constrictive.
http://www.videojug.com/film/how-to-make-an-elevation-sling

[Anonymous]

"Any thoughts??"

Sounds like you "shock loaded" your right arm. It could be a partial tear of your biceps and triceps. If I were you, I would PM both Dean Fellabaum and John Shannon(they are both docs) and see what they think. Be sure to include your description of what happened and the picture you posted). Best of luck, Peter.

[James Lantz]

Peter,
Your injury appears to be a torn biceps brachii muscle. From the appearance on the photograph, it appears to be at the belly of the muscle with residual blood tracking to the elbow due to its dependent posture while at rest. If you are able to curl your arm with the muscle making a relatively normal contour, it is likely torn fibers or a bundle & not a complete tear. If your pain is at the front of the shoulder, it could be a tendon tear of the long head biceps tendon again with blood tracking down the arm due to gravity. I am a physician (internal medicine) & not an orthopedist. I would recommend that you see an orthopedist because if it is a tendon rupture or avulsion, this would need surgical repair. I had a similar injury about 20 yrs ago due to weight training & had to have surgery to reattach the avulsed tendon. Hope this info helps you decide the best course of action for you.

[josh wagner]

that makes me twinge just looking at it!

[Peter Sustr]

Thanks for all your help guys, I appreciate it. So you know I will be posting a trip report video tomorrow.

To answer some more questions:

I took the picture about 15 min before posting.
I am able to curl my arm without much pain- 3 on a scale of 1-10; I mostly get pain in my bicep when I try to reach for something or move it in a 'unnatural' movement; i.e. not up/down side/side.

I did carry a pack for 3 days after the accident so I probably irritated it more this way.

Here is one more pic of the elbow and bicep

Again, thanks for your help, being uninsured is a crazy thing.

[YAMABUSHI !]

you got enough good advice,

so ill save my arm chair MD opinions

but jeez feel better

[John S.]

It's a bruise on the outside appearance. I gather you wrapped your arm around the shrub at the elbow to stop your fall. Whether or not there is further damage to the biceps tendon/muscle cannot be known from a picture. If complete tendon tear you'd usually have the biceps muscle contract and ball up in your upper arm. I don't see that, and you'd likely know something major was wrong. A partial tear could have occured.

If I didn't see an obvious torn muscle and I could use my arm with not much pain, I'd give it a week and take over the counter pain relievers. Use the arm as little as possible for a week. If tylenol or ibuprofen doesn't help and/or you have trouble sleeping, OR if it's not better in one week, go see a physician. Please give follow-up in a few days.

[backpackerchick]

Bruised for sure.

Are you taking Aspirin or Plavix, etc. NSAIDs even? These can lead to more marked bleeding/bruising. Bruise easily?

Did you take impact to the region in question? Hit the arm against a rock, stump? Looks consistent with this scenario.

Did you feel any unusual sensation when you did it?

Hope you feel better soon :)

[Dean F.]

With that lump on the back of your arm (unless it's just an artifact of the photograph) I'd worry about a torn biceps or triceps. You say it hurts when you extend your arm (i.e. reach for something)? Sounds like triceps- as does the location of the lump. That wouldn't well explain why you have a bruise on your biceps, too, though.

Without examination it's hard to tell. Almost any doc can put his hand on your arm, ask you to flex it a few times, and make the diagnosis, though, if there is a ruptured muscle or tendon.

Unless that lump isn't real, I'd say get checked.

But then again there is nothing life-threatening about the injury. It doesn't sound like a complete rupture. If you are satisfied with your current function in that arm you COULD just let the thing heal and accept a little loss of function. If you go this route be sure to do stretches religiously or you could get a contracture of some kind.

But I'd recommend at least talking to an orthopedist about it if you do have a rupture. Expensive for the uninsured, I know…

Of course if you ask any doctor about ANY medical problem over the internet we're going to tell you to get checked. We hate dispensing advice without really being able to examine you.

[John S.]

With Dean being an ER physician, his advice is best. I thought the triceps area "lump" was due to constrictive effect of the shirt sleeve being pulled up.

[Peter Sustr]

I appreciate the medial advice. I know its hard to just look at a picture and give a diagnosis but, I thank you for taking the time.

The lump you saw on the right side of my arm is just from my fat arm, there is no pooling or anything like that just fat.

I am stupid, I forgot to mention that I do take 7.5 mg of Cumadin everyday so I do bruise easily and that is why its looks so bad i'm sure.

You can see my trip report under ;Grand Gulch Thanksgiving week in the trip report forum.

[James Lantz]

Peter,
The coumadin certainly does have a tremendous bearing on your injury. Had the muscle tear been severe, one would have expected severe swelling & bruising so the degree of bruising you have seems to be reasonable given this context. While uninsured, please, please, please resist any temptation not to have your protime regularly checked, even if it means going to a "walk in lab" to have it drawn. Also, I'm sure you know not to take Ibuprofen, Naproxen, or Aspirin for this injury since you are on coumadin.

[Roger Caffin]

Hi Peter

Caution: I am NOT a medico.

However, given that you are on Coumadin, I wonder whether what you are showing is just bad bruising. The elbow region may be where you crashed down on the rock, while the other bruise higher up may be where you impacted a small tree or bush as you fell/slid – or your pack strap slammed you. (Having done something very similar once, and come to hanging onto a small tree …)

IF there is real muscle damage you don't want to leave it for too long before getting it repaired, but if you retain arm movement and strength for all motions without sharp pain, I would be inclined to wait a few days and to keep 'testing' the muscles.

But, I am not a medico.

Cheers

[Anonymous]

Peter,

The Coumadin puts things in a different light, IMO. I guess I'm wondering if you might not want to consider backing off a bit on the risk level of your adventures. If you took a more serious tumble and got some trauma induced internal bleeding in your torso, you could be in for some serious trouble. I'm not medically trained, but I am concerned for you. I'll end by inviting Dean, John, and James, doctors all, to weigh in on this before shutting my yap for good.

[Peter Sustr]

The cumadin does change things and its something I've lived with for over 10 years now, I have DVT, I also have crohn's disease for the past 5. My body is not in the best medical shape but, I decided long ago that I can't live my life sheltered from all things that might hurt me. I hike fully aware of the risks and have a huge first aid kit that I take just in case of a big cut or other situations like that, definitely not UL :)

My crohn's does/has prevented me from doing some things but, I try not to let it dictate my life.

I don't take risks when I go out, I assess it and take what I think is the right actions.

I'm going to wait a few more days and see what happens with my arm. I'll keep you guys posted.

[backpackerchick]

How are you doing today?

Good for you for not letting these conditions stop you. As you no doubt realize Coumadin/Warfarin has a number of drug/food interactions which can impact anticoagulation — either increase the INR or decrease the INR. It is important not to blow off routine monitoring. You don't want to reach supra-therapeutic levels and if you do you want to have a plan in place. There are home monitoring kits. I don't know if these have caught on in the US.

Recommendations regarding anticoagulation for various indications are always evolving. For some indications, there are options other than warfarin. You may find it empowering and helpful to follow this debate. The basic physiology is not too difficult. Always easier to study something when you have a vested interest! Haematology is an awesome field populated by the intellectually curious. If you have a blood dyscrasia that predisposes you to DVT, haematologists may find you exciting which is always a bonus.

Struggle to find balance between bleeding and clotting. There are obvious risks involved in swinging too far in either direction.

As for mechanism of injury, Roger's post sounds consistent with the description given. (These are simply my musings and do not constitute medical advice.)

[Dean F.]

>> With Dean being an ER physician,

Bite Your Tongue, John! I'm a general surgeon. :o)

(That's why I'm so abrasive…)

[Peter Sustr]

Hey guys,

wanted to give you an update. The bruising is gone except for a small one one my elbow. Other then that the bruising is gone. I do still have some discomfort when I fully extend my arm but, that is getting better every day.

Thanks again to everyone who chimed in.

[josh wagner]

gotta be a big relief. i know how it is without insurance. i went without it for 3 years and i kinda had to hold my breath a bit anytime i did anything active! glad it's working itself out

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