Biceps tendon rupture: Difference between revisions

No edit summary
(8 intermediate revisions by 3 users not shown)
Line 1: Line 1:
==Background==
==Background==
[[File:1120 Muscles that Move the Forearm Humerus Flex Sin.png|thumb|Biceps tendon anatomy.]]
*Vast majority are proximal
*Vast majority are proximal
*Occurs with sudden or prolonged contraction in patient with chronic bicipital tenosynovitis
*Occurs with sudden or prolonged contraction in patient with chronic bicipital tenosynovitis


==Clinical Features==
==Clinical Features==
[[File:PMC3716025 JCHIMP-3-20688-g001.png|thumb|Popeye's sign in patient with biceps tendon rupture.]]
*Snap or pop is described
*Snap or pop is described
*Flexion of elbow elicits pain
*Flexion of elbow elicits pain
Line 33: Line 35:
**Mostly nonoperative for elderly, with most patients asymptomatic after 4-6 weeks
**Mostly nonoperative for elderly, with most patients asymptomatic after 4-6 weeks
*Distal rupture requires tenodesis, sutures to anchor tendon into radius
*Distal rupture requires tenodesis, sutures to anchor tendon into radius
==Disposition==
*Outpatient management


==See Also==
==See Also==
[[Elbow diagnoses]]
*[[Elbow diagnoses]]
*[[Shoulder and upper arm diagnoses|Shoulder diagnoses]]


==Sources==
==References==
<references/>
<references/>


[[Category:Orthopedics]]
[[Category:Orthopedics]]
[[Category:Sports Medicine]]

Revision as of 15:01, 8 June 2019

Background

Biceps tendon anatomy.
  • Vast majority are proximal
  • Occurs with sudden or prolonged contraction in patient with chronic bicipital tenosynovitis

Clinical Features

Popeye's sign in patient with biceps tendon rupture.
  • Snap or pop is described
  • Flexion of elbow elicits pain
  • May produce mid-arm "ball" but difficult in obese patients
  • Proximal
    • Swelling and tenderness over bicipital groove
    • Loss of strength is minimal due to intact short head inserting at corocoid process
  • Distal
    • Swelling and tenderness over antecubital fossa
    • Inability to palpate distal biceps tendon in antecubital fossa
    • Hook test (~100% sensitive and specific, as compared to MRI which is 92% and 85%, respectively)[1]
      • Patient actively supinates and flexes elbow to 90 degrees
      • Hook the distal biceps tendon insertion at radial head to evaluate whether intact
Hook test

Differential Diagnosis

Elbow Diagnoses

Radiograph-Positive

Radiograph-Negative

Pediatric

Shoulder and Upper Arm Diagnoses

Traumatic/Acute:

Nontraumatic/Chronic:

Refered pain & non-orthopedic causes:

Evaluation

Management

  • Proximal rupture
    • Sling, ice, NSAIDS, physical therapy, referral to ortho
    • Surgical tenodesis is usual for young, active patients
    • Mostly nonoperative for elderly, with most patients asymptomatic after 4-6 weeks
  • Distal rupture requires tenodesis, sutures to anchor tendon into radius

Disposition

  • Outpatient management

See Also

References

  1. O'Driscoll SW, Goncalves L, and Dietz P. The Hook Test for Distal Biceps Tendon Avulsion. The American Journal of Sports Medicine 35(11):1865-9. December 2007.