Biceps tendon rupture
Background
- Vast majority are proximal
- Occurs with sudden or prolonged contraction in patient with chronic bicipital tenosynovitis
Clinical Features
- 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
- Patient actively supinates and flexes elbow to 90 degrees
- Hook the distal biceps tendon insertion at radial head to evaluate whether intact
Differential Diagnosis
Elbow Diagnoses
Radiograph-Positive
- Distal humerus fracture
- Radial head fracture
- Capitellum fracture
- Olecranon fracture
- Elbow dislocation
Radiograph-Negative
- Biceps tendon rupture/dislocation
- Lateral epicondylitis
- Medial epicondylitis
- Olecranon bursitis (nonseptic)
- Pronator teres syndrome
- Septic bursitis
Pediatric
- Nursemaid's elbow
- Supracondylar fracture
- Lateral epicondyle fracture
- Medial epicondyle fracture
- Olecranon fracture
- Radial head fracture
- Salter-Harris fractures
Shoulder and Upper Arm Diagnoses
Traumatic/Acute:
- Shoulder Dislocation
- Clavicle fracture
- Humerus fracture
- Scapula fracture
- Acromioclavicular joint injury
- Glenohumeral instability
- Rotator cuff tear
- Biceps tendon rupture
- Triceps tendon rupture
- Septic joint
Nontraumatic/Chronic:
- Rotator cuff tear
- Impingement syndrome
- Calcific tendinitis
- Adhesive capsulitis
- Biceps tendinitis
- Subacromial bursitis
- Cervical radiculopathy
Refered pain & non-orthopedic causes:
- Referred pain from
- Neck
- Diaphragm (e.g. gallbladder disease)
- Brachial plexus injury
- Axillary artery thrombosis
- Thoracic outlet syndrome
- Subclavian steal syndrome
- Pancoast tumor
- Myocardial infarction
- Pneumonia
- Pulmonary embolism
Evaluation
- Obtain radiographs to rule-out avulsion fracture
- Ultrasound can help with diagnosis
Management
- Sling, ice, NSAIDS, and referral to ortho
- Surgical repair is usual for young, active patients