Biceps tendon rupture

Background

• Vast majority are proximal
• Occurs w/ sudden or prolonged contraction in pt w/ 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
• Loss of strength is minimal
• Proximal
  • Swelling and tenderness over bicipital groove
• Distal
  • Swelling and tenderness over antecubital fossa
  • Inability to palpate distal biceps tendon in antecubital fossa

Differential Diagnosis

Elbow Diagnoses

Radiograph-Positive

• Distal humerus fracture
• Radial head fracture
  • Essex-Lopresti fracture
• Capitellum fracture
• Olecranon fracture
• Elbow dislocation

Radiograph-Negative

• Biceps tendon rupture/dislocation
• Lateral epicondylitis
• Medial epicondylitis
• Olecranon bursitis (nonseptic)
• Pronator teres syndrome
• Septic bursitis

Pediatric

• Nursemaid's elbow
• Supracondylar fracture
• Lateral epicondyle fracture
• Medial epicondyle fracture
• Olecranon fracture
• Radial head fracture
• Salter-Harris fractures

Diagnosis

• Obtain radiographs to rule-out avulsion fracture
• Ultrasound can help with diagnosis

Management

• Sling, ice, NSAIDS, and referral to ortho
  • Surgical repair is usual for young, active pts

See Also

Elbow diagnoses