Makindo Medical Notes

ℹ️ About

• 💪 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

• Orthobullets – Biceps Rupture
• TeachMeSurgery – Biceps Rupture