Distal Biceps tendon rupture

Clinical presentation

Patient may present after a painful "pop" at the elbow as it is loaded from flexion to extension. There maybe pain and weakness with elbow movement. Useful information in the history includes detailed mechanism of injury, hand dominance and occupation.

Examination

Main findings supporting distal bicep tendon rupture include

• Loss of more supination than flexion

• "Reverse Popeye sign" - proximal retraction of bicep muscle belly

• "Hook test" - with elbow in 90 deg and fully supinated, attempt to hook the lateral edge of biceps tendon (intact tendon allows examiner to insert finger 1cm deep to tendon).

Imaging

The diagnosis of distal bicep tendon can be made clinically.

Tears can be confirmed and evaluated using ultrasound or MRI but these are not routine.

A&E management

1. Analgesia

2. Broad arm sling

3. Referral to Ortho on-call to confirm diagnosis clinically