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 (~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

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.