Biceps tendon rupture: Difference between revisions
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==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:PMC4764315 PAMJ-22-258-g002.png|thumb|“Popeye's sign” pathognomonic of distal biceps tendon rupture.]] | |||
[[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 | ||
*May produce mid-arm "ball" but difficult in obese patients | *May produce mid-arm "ball" but difficult in obese patients | ||
==Differential Diagnosis== | |||
{{Elbow DDX}} | |||
{{Shoulder DDX}} | |||
==Evaluation== | |||
===Workup=== | |||
*Obtain radiographs to rule-out avulsion fracture | |||
*[[Ultrasound: Tendons|Ultrasound can help with diagnosis]] | |||
===Diagnosis=== | |||
[[File:Hook test.JPG|thumbnail|Hook test]] | |||
*Proximal | *Proximal | ||
**Swelling and tenderness over bicipital groove | **Swelling and tenderness over bicipital groove | ||
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***Patient actively supinates and flexes elbow to 90 degrees | ***Patient actively supinates and flexes elbow to 90 degrees | ||
***Hook the distal biceps tendon insertion at radial head to evaluate whether intact | ***Hook the distal biceps tendon insertion at radial head to evaluate whether intact | ||
==Management== | ==Management== | ||
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**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== | ||
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*[[Shoulder and upper arm diagnoses|Shoulder diagnoses]] | *[[Shoulder and upper arm diagnoses|Shoulder diagnoses]] | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
[[Category:Sports Medicine]] | |||
Latest revision as of 04:41, 8 January 2022
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
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
Workup
- Obtain radiographs to rule-out avulsion fracture
- Ultrasound can help with diagnosis
Diagnosis
- 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
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
- ↑ 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.