MANUAL MINORS
A biceps tendon rupture can affect both the long head of the biceps (at the shoulder) and the distal tendon (near the elbow). Ruptures of the long head of the biceps are more common due to repetitive use or trauma.
Distal biceps tendon ruptures are less frequent but more severe, typically occurring during intense effort, such as lifting heavy objects. Symptoms include sharp pain, visible deformity (“Popeye sign”), and loss of strength.
Diagnosis
Diagnosis is based on a clinical history of a traumatic event, with acute pain in the affected area followed by weakness or inability to flex the elbow or supinate the forearm. In proximal ruptures, a visible “bulge” in the lower arm is the retracted muscle (Popeye sign).
Physical tests, such as Ludington’s test, can confirm proximal rupture. Distal ruptures cause significant loss of strength, particularly during palm-up (supination) movements. Ultrasound or magnetic resonance imaging (MRI) is used to confirm the extent of the rupture and differentiate between partial or complete tears.
Differential Diagnosis
Pathology | Characteristics |
|---|---|
Rotator cuff tear | Shoulder pain and weakness, especially when lifting the arm, without biceps deformity |
Bicipital tendinitis | Pain in the front of the shoulder, without visible deformity or severe weakness |
Medial collateral ligament sprain | Elbow pain after effort, without significant loss of biceps strength |
Biceps dislocation | Displacement of the biceps tendon with a “snapping” sound when moving the arm, without complete rupture |
Muscle contusion | Biceps pain after trauma, without functional loss or deformity |
Emergency Management
Initial emergency management includes immobilising the affected arm with a sling to relieve pain and prevent further movement. Non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics are used for pain control.
In cases of distal rupture or significant loss of function, urgent referral for surgical evaluation is necessary. Ice application during the first few hours can help reduce swelling.
Definitive Treatment
Treatment depends on the type and severity of the rupture:
Proximal ruptures (long head of the biceps): Typically managed conservatively, as the overall function of the biceps may be preserved. Treatment includes rest, physiotherapy to restore strength and range of motion, and NSAIDs for pain control.
Distal ruptures (near the elbow): These require surgery due to significant functional loss. Surgical repair involves reattaching the tendon to the radius using sutures or bone anchors. Postoperative recovery includes immobilisation followed by physiotherapy to restore mobility and strength.
Rehabilitation is essential in both cases to prevent complications such as persistent weakness or joint stiffness.
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