Question
Hello

Two weeks ago I took a hard crash off my dirt bike and landed on my outstretched Left arm and leg.  I hyperextended my knee a bit but the main injury was to my arm and what I thought at first was my shoulder.  I have torn my AC tendon and broken my collar bone in the past and neither of those injuries are like what I am experiencing now.  At the time of the crash I believe I heard a pop and at first i thought I broke my left clavicle.  I ended up going to the ER.  X-rays were taken and I was released with no real concern from the DOC.  I followed up two days later with an orthopedic Dr. and he said that I should followup in four weeks since I was too sore to do any kind of movements.  Heavy amount of blood ( bruising ) could be seen on the inner part of my arm as well as on my left pec (chest) muscle.  I have been trying to do range of motion movements and they have been ok except that I have extreme pain and burning if i were to twist my arm in an up and down motion as if i were arm wrestling someone.  I can start my left arm directly out from me bent 90 degrees (parallel with the ground) and if I leave my elbow stationary I can only pivot the top of my arm up from there 45 degrees.  If I were to move past there I would be in extreme pain.  My question is

1.  does this sound like a tricept/ biceps tear ?
2.  Should i be doing range of motion exercises at two weeks or how long should i wait?
3.  How long could the recovery be?
4   When Can I ride My dirt bike again?  : )

I also have pain in the muscle of my shoulder at the top of my arm on the outside deltoid.  The Dr. ruled out a shoulder separation.

Thanks for any help offered

Jon

Answer
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Hello J.,

Wow, that sounds like quite the spill you took.  You should definitely follow any recommendations your doctor gives you and keep your appointment with the orthopedist.  Please realize that any information provided is not to be taken as fact, specific to your individual circumstances or case, or as a qualified opinion.  All the information provided is for general knowledge and not educational purposes only.

Anytime there is injury to connective tissues, such bones, ligaments, muscles, etc? vitamin C helps the connective tissues repair.  Talk to your doctor about supplementing with vitamin C.

Even though the acute stage of inflammation is classically noted for the first 1-3 days after an injury, in much more severe cases, it can last longer.  To prevent as much scar tissue from forming as your injuries heal, and so that the injury heals quicker, it抯 best to use ice.  It抯 safer to assume that at this point the heat will aggravate the condition further.  Though it may take away the pain temporarily, it can actually cause more damage on an acute injury, even though the heat may feel soothing.  As always, make sure that if you do ice, to not ice longer than 10-15 minutes a session, no more than once per hour, and to wrap the ice in a towel to protect the skin.

Your doctor might want to prescribe or recommend some anti-inflammatory medications.  If you prefer the natural route, talk to your doctor about supplementing with a good fish oil or flaxseed oil to keep your inflammatory process in check.

As far as exercises go, you definitely need evaluation.  The older school of thought used to recommend complete rest following many (not all) injuries.  Newer research indicates that it may be best to do some light mobilization/range of motion exercises to keep things circulating and to accelerate the healing.  The purpose of checking with your doctor is to rule out any major muscle tears or avulsions not caught by the x-ray.  If you incorporate any gentle stretches or range of motion exercises, it may be a good idea to follow up with an ice treatment to modulate any inflammation.

Sprains and strains can take anywhere from 4-8 weeks to heal, depending on the severity of the injury.  If bad enough, severe ligament sprains can take even take longer than mild fractures to heal.  The reason for the length is because of the very poor circulation ligaments and tendons have.  The connective tissue is very dense in these areas, which compromises their ability to heal well following an injury.  The other thing to keep in mind is that even when the pain is completely gone, it抯 possible the injuries are still present and healing, so don抰 overdo things once you start to feel yourself again.

It is impossible to tell whether or not the biceps brachii or triceps muscles are torn without an evaluation.  In some instances, an MRI can be necessary to visualize where and how severe of a tear is present, as well as to exclude the possibility of a tear.  In severe tears, doctors might need to operate to repair the muscle.  Given your description, a muscle tear is something that is very possible and to have ruled out by your doctor.  In addition, it sounds as if there may be some rotator cuff involvement, which the orthopedist will be able to determine.

And lastly, don抰 worry about the dirt bike for now.

Best of luck, and I hope this gives you a bit of direction.

Dr. JR Strecker, DC