From the Guidelines
Assessment of a suspected biceps tendon rupture requires a thorough clinical examination followed by appropriate imaging, with MRI being the most accurate modality for detecting distal biceps tendon ruptures and partial tears, as reported by 1 with a sensitivity and specificity of 92.4% and 100%, respectively. The initial evaluation should include:
- Inspection for asymmetry, deformity (particularly the "Popeye" sign where the biceps muscle belly appears bunched up), and ecchymosis
- Palpation to assess for tenderness and defects along the tendon course
- Specific tests, such as:
- Speed's test (resisted forward flexion of the shoulder with the elbow extended and forearm supinated)
- Yergason's test (resisted supination with the elbow flexed at 90 degrees)
- The hook test for distal ruptures (inability to hook the finger under the biceps tendon) Imaging should begin with plain radiographs to rule out associated injuries, followed by ultrasound which offers dynamic assessment, but MRI is the preferred imaging modality for its high accuracy in detecting partial tears and complete ruptures, as supported by 1 and 1. Treatment depends on the location of the rupture, patient age, activity level, and functional demands, ranging from conservative management with physical therapy to surgical repair, particularly for young, active patients with complete tears of the distal biceps tendon where early surgical intervention (within 2-3 weeks) provides optimal outcomes, as suggested by 1 and 1.
From the Research
Assessment for Suspected Biceps Tendon Rupture
The assessment for suspected biceps tendon rupture involves a combination of physical examination, medical history, and diagnostic tests.
- Physical examination findings may include:
- Diagnostic tests may include:
Importance of Prompt Diagnosis
Prompt diagnosis and referral to orthopedic surgery are crucial to optimize outcomes and minimize complications after distal biceps brachii tendon rupture 2.