Biceps Tendon Rupture

Question 1

What is more common - proximal or distal biceps tendon ruptures?

Answer 1

> 90% ruptures involve proximal biceps tendon of long head of biceps

Question 2

Causes of distal biceps tendon rupture

Answer 2

Usually traumatic (e.g. tug of war)
Excessive eccentric overload at the elbow

Question 3

What age group/gender is most commonly affected by distal biceps tendon rupture

Answer 3

35-50yo patients
More common in males

Question 4

Causes of proximal biceps tendon rupture

Answer 4

Associated with repetitive microtrauma (e.g. rotator cuff pathology)

Question 5

What age group/gender is most commonly affected by proximal biceps tendon rupture

Answer 5

More common in elderly or younger patients during heavy weight lifting/sports or fall

Question 6

Presentation of distal biceps tendon rupture

Answer 6

May report sudden sharp anterior shoulder pain or elbow pain during activity associated with audible pop or snapping sensation.

Question 7

Presentation of proximal biceps tendon rupture

Answer 7

May have recurrent pain with overhead or repetitive activities that require elbow flexion
May have nondescript anterior shoulder pain that worsens at night

Question 8

Which type of biceps tendon rupture might pain actually improve?

Answer 8

May have reduced pain with complete (proximal) rupture if follows chronic impingement and irritation

Question 9

Examination - look

Answer 9

Deformity e.g. Popeye sign
Bruising
Swelling

Distal ruptures can result in a painful, swollen elbow

Question 10

What is the “Popeye” sign

Answer 10

In proximal ruptures, the biceps tendon appears bunched up in the distal arm

Question 11

Examination - feel

Answer 11

Palpate along tendon for tenderness
Feel for the biceps tendon in the elbow (Hook test)

Question 12

Examination - move

Answer 12

Shoulder and elbow ROM and strength.

Question 13

How to do Hook test

Answer 13

With the patient’s shoulder elevated, elbow flexed, and arm supinated try to “hook” the biceps tendon

Question 14

What does the Hook test tell you

Answer 14

Inability to “hook” the biceps tendon is considered a positive test for a complete rupture
Reproduction of pain with palpation of the biceps tendon is indicative of a partial tear

Question 15

What is the most sensitive clinical sign for biceps tendon rupture

Answer 15

Weakness or pain with resisted forearm supination

Question 16

Are investigations needed for suspected biceps rupture?

Answer 16

Clinical diagnosis
Ix (xray / USS shoulder) only if diagnosis uncertain

Question 17

Management of proximal biceps tendon ruptures

Answer 17

Usually treated conservatively, physio not usually required
Rest, followed closely by ROM and strengthening exercises for the shoulder and elbow.

Question 18

Management of proximal biceps tendon ruptures - who should you consider referral to ortho for surgical repair

Answer 18

< 40yo + physically active

Question 19

Outcomes for conservative management of proximal biceps tendon ruptures

Answer 19

Can lose up to 20% of supination strength but overall doesn’t impact function/ADLs

Question 20

Management of distal biceps tendon ruptures

Answer 20

Better managed surgically to maintain supination strength