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Biceps tendon rupture
Related Subjects: |Fractured Neck of Femur |Fractured Shaft Femur |Supracondylar Femur Fractures |Femoral fractures and Injuries |Acromio-clavicular joint |Shoulder Joint Structure and Form |Knee Joint Structure and Form |Wrist Joint Structure and Form |Types of Joints |Biceps tendon rupture |Upper Limb fractures and injuries |Hand fractures and Injuries |Lower Limb Fractures and Injuries
💪 Biceps Rupture: Refers to tearing of the biceps tendon, either partial or complete. – Proximal (shoulder): usually the long head tendon. – Distal (elbow): tendon attaches to radial tuberosity. – More common in males, often linked with heavy lifting or degeneration.
📂 Types of Biceps Rupture
- 🔹 Long Head (Proximal) Rupture:
- 👴 Often spontaneous in older adults due to degeneration.
- Characteristic “Popeye sign” – bulging distal biceps belly after tendon retracts.
- Associated with rotator cuff pathology in up to 40% of cases.
- Usually managed non-operatively unless persistent weakness or cosmetic concerns.
- 🔹 Distal Biceps Rupture:
- 📍 Occurs at insertion onto the radius in the forearm.
- Symptoms: anterior elbow pain, swelling, bruising, loss of supination strength.
- Leads to ~30–50% loss of forearm supination strength if untreated.
- ⚠️ Requires early surgical repair; delayed repair is more complex and less successful.
🔎 Investigations
- 🩻 X-ray: To check for avulsion fractures (especially in distal ruptures).
- 🖥️ Ultrasound: Quick, dynamic, useful for proximal tears.
- 🧲 MRI: Gold standard for defining extent of tear and associated shoulder/elbow pathology.
💊 Management
- ⚡ Acute Treatment:
- Rest, ice, analgesia to reduce swelling and pain.
- Sling/brace for short-term immobilisation.
- 💪 Proximal Rupture:
- Most do well without surgery, especially if low functional demands.
- Some residual weakness in shoulder flexion or cramping may occur.
- 🦴 Distal Rupture:
- Surgical repair strongly recommended for active patients.
- Restores supination and flexion strength; rehab takes several months.
- 🏋️ Rehabilitation:
- Physiotherapy essential post-injury or post-surgery.
- Gradual strengthening and stretching to restore range and prevent stiffness.
📌 Exam Pearl: – “Popeye sign” = proximal long head rupture. – Loss of supination strength = distal rupture (needs surgery). – Always consider underlying rotator cuff tear in proximal injuries.
📚 References
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