Biceps tendon rupture

Background

  • 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.