Case: A 46-year-old man presented with extensive swelling and ecchymosis of the arm and antecubital fossa after a 4-foot fall from a ladder in which he attempted to arrest his decent by grabbing onto a wooden ceiling beam. Ultrasound and magnetic resonance imaging confirmed a complete intrasubstance rupture of the biceps brachii. Nonoperative management was recommended and, at 9-week follow-up, the patient had resumed light weightlifting and demonstrated painless full active range of motion.
Conclusions: Uncommon complete intrasubstance biceps brachii ruptures can occur via an atypical mechanism of isotonic eccentric muscle contraction and satisfactory results may be realized through nonoperative management.