From the Guidelines
To evaluate for a biceps tear, start with a thorough physical examination and consider MRI as the preferred imaging modality due to its high sensitivity and specificity, as reported in a 2022 study with sensitivity and specificity of 92.4% and 100%, respectively, for detecting distal biceps tendon ruptures 1. When evaluating for a biceps tear, it is essential to begin with a comprehensive physical examination, focusing on signs such as pain, swelling, bruising, and deformity in the upper arm. The "Popeye sign," a visible bulge in the lower arm caused by the retracted biceps muscle, is a key indicator. Strength testing, including flexion of the elbow against resistance and supination, as well as special tests like Speed's test and Yergason's test, can help identify potential tears. Imaging studies play a crucial role in confirming the diagnosis. While ultrasound is a quick and cost-effective option, MRI is preferred for its detailed visualization of the tear's extent and associated injuries, with a recent study in 2024 highlighting its superiority over ultrasound in detecting the type of distal biceps tendon tear 1. X-rays can help rule out bone injuries but are not effective in directly visualizing soft tissue damage. The evaluation process should also consider the patient's activity level, hand dominance, and functional requirements to guide treatment decisions. Complete tears often present with immediate sharp pain followed by weakness, whereas partial tears may have a more gradual onset of symptoms. Key points to consider in the evaluation process include:
- Thorough physical examination
- Use of MRI for detailed imaging
- Assessment of patient's activity level and functional requirements
- Differentiation between complete and partial tears based on symptom onset and severity. Given the evidence, MRI is the recommended imaging modality for evaluating biceps tears due to its high accuracy and ability to provide detailed information necessary for treatment planning 1.
From the Research
Evaluation of Bicep Tears
To evaluate for a bicep tear, several methods can be employed, including physical examination tests and imaging studies.
- The biceps palpation-rotation test can be used to diagnose partial distal biceps tendon tears, with a sensitivity of 100% as seen in 2.
- The Hook test can also be used, but it was found to be negative in all cases of partial distal biceps tendon tears in 2.
- Tenderness on resisted supination is another indicator of a partial distal biceps tendon tear, as noted in 2.
- A combination of the Hook test and biceps crease interval (BCI) can be used to diagnose acute complete ruptures of the distal biceps tendon, with a sensitivity of 94% and specificity of 100% as seen in 3.
- Weakness on active supination and palpation of the tendon footprint can provide excellent sensitivity for chronic complete ruptures and partial ruptures, respectively, as noted in 3.
Imaging Studies
Imaging studies such as magnetic resonance imaging (MRI) can be used to confirm the diagnosis of a bicep tear.
- MRI can accurately grade distal biceps tendon injury preoperatively, with 100% agreement between MR imaging and surgical findings as seen in 4.
- Axial MR images are more valuable than sagittal images in accurately grading distal biceps tendon injury, as noted in 4.
- MRI can also lead to changes in clinical treatment plans, as seen in 38% of patients in 4.
Diagnostic Strategy
A diagnostic strategy for distal biceps tendon ruptures can involve a combination of physical examination tests and imaging studies.
- A combination of the Hook test, passive forearm pronation test, biceps crease interval (BCI), and biceps crease ratio can be used to diagnose complete and partial ruptures, as seen in 3.
- Additional imaging such as MRI or ultrasound can be used to confirm the diagnosis and guide treatment, as noted in 3.