Distal Biceps Tendon Ruptures
A) Rest, NSAIDs and return to lifting as tolerated
B) Referral to orthopedic surgery
C) Hinged elbow sleeve, early ROM and therapy
D) Platelet rich plasma and then physical therapy
Figure 1. Distal Biceps Tendon Anatomy (Adopted from )
On examination, there may be a bulge proximal to the insertion, which is sometimes called a “Reverse Popeye” deformity. There will be asymmetric weakness in supination and elbow flexion when compared to the opposite side. The provider can also isolate the biceps from the supinator by flexing the elbow to 90 degrees with the arm in maximal supination and testing supination strength. The most common special test is the hook test, which has been shown to have a high specificity and sensitivity . The examiner uses their finger to capture the lateral edge of the distal biceps tendon. If the tendon is intact, the examiner should be able to insert the finger roughly one centimeter underneath the tendon . The provider should compare the appearance of the biceps when the elbow is flexed to 90 degrees to compare the contour and musculature of the opposite biceps tendon, as there may be some variation between individuals. The passive forearm pronation (PFP) test is based on the observation that the biceps muscle belly moves proximally with forearm supination and distally with forearm pronation, both actively and passively. The examiner moves the patient’s forearm through a passive range of supination and pronation, using both palpation and visualization to assess for appropriate movement of the biceps muscle belly.
Figure 2. Demonstration of biceps crease interval (adopted from )
Figure 4. A shows biceps tendon partial tear on long axis oblique view. B shows the same on short axis anterior view. C shows the an image of the partial tear with radial tuberosity (RT) labeled. D shows the axial MRI image of the same partial tear.
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