JOE SULLIVAN, BASEBALL

• 1893: While 4 or 5 errors a season is acceptable, some playerskeep their jobs with a dozen or more.

• The Washington Senators'Sullivan, however,committed 106 errors in one season, a record that still stands more than 100 years later.

• It was rumored fans came to the ballgame as much to watch Joe drop the ball as they did to see the game.

• Diagnosed with a right biceps strain after coming out in the fifth inning of Saturday's 5-0 loss to the Toronto Blue Jays.

Biceps Muscle

biceps brachii muscle

• The is the one that gave all muscles their name:

• it comes from the Latin musculus, "little mouse", because the appearance of the flexed biceps resembles the back of a mouse.

• The same phenomenon occurred in Greek, in which μῦς, mȳs, means both "mouse" and "muscle".

Biceps Brachii

• two-headed muscle. • The biceps lies on the

upper arm between the shoulder and the elbow.

• Both heads arise on the scapula and join to form a single muscle belly which is attached to the upper forearm.

• its main function is at the latter where it flexes the elbow and supinates the forearm.

• Both these movements are used when opening a bottle with a corkscrew: first biceps unscrews the cork (supination), then it pulls the cork out (flexion).

• Traditionally described as a two-headed muscle, biceps brachii is one of the most variable muscles of the human body and has a third head arising from the humerus in 10% of cases (normal variation) — most commonly originating near the insertion of the coracobrachialis and joining the short head — but four, five, and even seven supernumerary heads have been reported in rare cases.

• The distal biceps tendons are completely separated in 40%

and bifurcated in 25% of cases.

Palpation

Yeagerson’s Test

Speed Test

Biceps reflex

• Biceps brachii is innervated by the musculocutaneous nerve together with coracobrachialis and brachialis; like the latter, from fibers of the fifth and sixth cervical nerves.

• Humeroulnar joint (elbow) – The biceps brachii also functions as an important flexor of the forearm, particularly when the forearm is supinated.

• Functionally, this action is performed when lifting an object, such as a bag of groceries or when performing a biceps curl. When the forearm is in pronation (the palm faces the ground), the brachialis, brachioradialis, and supinator function to flex the forearm, with minimal contribution from the biceps brachii.

• The biceps is tri-articulate, meaning that it works across three joints.

• The most important of these functions is to supinate the forearm and flex the elbow.

• Proximal radioulnar joint (upper forearm) – Contrary to popular belief, the biceps brachii is not the most powerful flexor of the forearm, a role which actually belongs to the deeper brachialis muscle.

• The biceps brachii functions primarily as a powerful supinator of the forearm (turns the palm upwards). This action, which is aided by the supinator muscle, requires the elbow to be at least partially flexed.

• If the elbow, or humeroulnar joint, is fully extended, supination is then primarily carried out by the supinator muscle.

• Glenohumeral joint (shoulder) – Several weaker functions occur at the glenohumeral, or shoulder, joint.

• The biceps brachii weakly assists in forward flexion of the shoulder joint (bringing the arm forward and upwards). It may also contribute to abduction (bringing the arm out to the side) when the arm is externally (or laterally) rotated.

• The short head of the biceps brachii also assists with horizontal adduction (bringing the arm across the body) when the arm is internally (or medially) rotated.

• Finally, the short head of the biceps brachii, due to its attachment to the scapula (or shoulder blade), assists with stabilization of the shoulder joint when a heavy weight is carried in the arm.

• The proximal tendons of the bicep brachii are commonly involved in pathological processes and are a frequent cause of anterior shoulder pain.

• Disorders of the distal biceps brachii tendon typically result from partial and complete tears of the muscle.

• A pulled biceps results from overstretching and tearing some of the biceps muscle fibers and/or tendons. Pain and sometimes swelling are the usual symptoms.

Proximal biceps tendon rupture:

• This is when one of the two biceps tendons in the shoulder is torn away from the bone.

• Sudden shoulder pain and an odd-shaped bulge in the biceps are symptoms.

Distal biceps tendon rupture

• A tear of the biceps tendon at the forearm is unusual.

• Sudden pain over the front of the elbow and forearm weakness are symptoms.

Proximal biceps tendinitis (tendonitis)

• Repeated use of the biceps or problems in the shoulder can irritate the proximal biceps tendon.

• Pain in the shoulder and biceps is the main symptom.

Biceps contracture

• The biceps becomes permanently contracted, with the elbow bent.

• Biceps contracture may occur after a severe stroke.

Tears

• Partial tears are usually characterized by enlargement and abnormal contour of the tendon.

• In complete tears, discontinuity exists, and if the

bicipital aponeurosis is also disrupted, retraction called a "Popeye's deformity" sign.

• Tears of the biceps brachii occur in athletic activities and corrective surgery repairs biceps brachii tendon tears

• Since the long head of the biceps can act as a secondary stabilizer of the shoulder, it is also subject to injury during high speed overhead movements; repetitive overhead movements; or forceful shoulder activities when the elbow is straight.

Treatment of a bicep tear

• depends on the severity of the injury. In most cases, the muscle will heal over time with no corrective surgery.

• Applying cold pressure and using anti-inflammatory medications will ease pain and reduce swelling.

• More severe injuries require surgery and post-op physical therapy to regain strength and functionality in the muscle.

• Corrective surgeries of this nature are typically reserved for elite athletes who rely on a complete recovery.

The short head of biceps brachii

has been the subject of little investigation when compared to the long head or distal biceps tendons.

Short head of biceps

• the attachment of the short head of biceps to the coracoid is a muscular attachment with an aponeurosis on its anterior surface.

Conjoined tendon

• Both the coracobrachialis and the short head of biceps are known to originate from the coracoid process, the coracobrachialis being more medial.

• This proximal attachment of

the two muscles is often referred to as a conjoined tendon.

There are two main causes of biceps tendon tears: injury and overuse.

• If you fall hard on an outstretched arm or lift something too heavy, you can tear your biceps tendon.

• Many tears are the result of a wearing down and fraying of the tendon that occurs slowly over time. This naturally occurs as we age. It can be worsened by overuse - repeating the same shoulder motions again and again.

• Overuse can cause a range of shoulder problems, including tendonitis, shoulder impingement, and rotator cuff injuries. Having any of these conditions puts more stress on the biceps tendon, making it more likely to weaken or tear.

Short Head of the Biceps

• Rarely tears.

• Because of this second attachment, many people can still use their biceps even after a complete tear of the long head.

Risk for a tendon tear increases with:

• Age. Older people have put more years of wear and tear on their tendons than younger people.

• Heavy overhead activities. Too much load during weightlifting is a prime example of this risk, but many jobs require heavy overhead lifting and put excess wear and tear on the tendons.

• Shoulder overuse. Repetitive overhead sports - such as swimming or tennis - can cause more tendon wear and tear.

• Smoking. Nicotine use can affect nutrition in the tendon.

• Corticosteroid medications. Using corticosteroids has been linked to increased muscle and tendon weakness.

Symptoms

• Sudden, sharp pain in the upper arm• Sometimes an audible pop or snap• Cramping of the biceps muscle with strenuous use of the arm• Bruising from the middle of the upper arm down toward the

elbow• Pain or tenderness at the shoulder and the elbow• Weakness in the shoulder and the elbow• Difficulty turning the arm palm up or palm down• Because a torn tendon can no longer keep the biceps muscle

tight, a bulge in the upper arm above the elbow ("Popeye Muscle") may appear, with a dent closer to the shoulder.

Tear

• For many people, pain from a long head of biceps tendon tear resolves over time. Mild arm weakness or arm deformity may not bother some patients, such as older and less active people.

• In addition, if you have not damaged a more critical structure, such as the rotator cuff, nonsurgical treatment is a reasonable option. This can include:

• Ice. Apply cold packs for 20 minutes at a time, several times a day to keep down swelling. Do not apply ice directly to the skin.

• Nonsteroidal anti-inflammatory medications. Drugs like ibuprofen, aspirin, or naproxen reduce pain and swelling.

• Rest. Avoid heavy lifting and overhead activities to relieve pain and limit swelling. Your doctor may recommend using a sling for a brief time.

• Physical therapy. Flexibility and strengthening exercises will restore movement and strengthen your shoulder.

Surgical Treatment

• Surgical treatment for a long head of the biceps tendon tear is rarely needed. However, some patients who require complete recovery of strength, such as athletes or manual laborers, may require surgery.

• Surgery may also be the right option for those with partial tears whose symptoms are not relieved with nonsurgical treatment.

SLAP

• Specific injuries may include inflammation and irritation of the bicep tendon itself; a problem with the bicep tendon in conjunction with one of the rotator cuff tendons; or detachment of part of the tendon from the attachment point (SLAP tear).

• Biceps tendon tears will often occur due to trauma or extremely heavy lifting.

• Many biceps have been torn off by individuals during deadlifts.

• To focus on the short head of the biceps brachii, use a wide-grip when performing curling exercises.

Wide-Grip Barbell Curl

• To perform this exercise, stand with your feet shoulder-width apart and grasp the barbell with your hands in a wide underhand grip.

• With elbows at your side, exhale and lift your arms, raising the bar until your forearms are vertical. Inhale and slowly lower the barbell to the starting position.

• During all bicep exercises, it is important to go slower on the way down during the eccentric phase -- lengthening of the bicep.