Biceps tendon rupture

When a tendon of the biceps brachii ruptures, the muscle belly retracts, meaning that it goes from a lengthened position under tension at two attachments to a shortened position with a single attachment. This shortened position forms a bulge which is referred to as "Popeye's deformity," due to its similarity in appearance to the cartoon character Popeye. Other signs at the time of injury may include ecchymosis, swelling, and/or a sharp pain accompanied by an audible popping sound. ==Diagnosis==

History Patient may describe that they felt a sudden audible popping sound under strenuous load at the time of injury. Ruland biceps squeeze test - The patient is asked to place his arm in about 60 to 80 degrees of flexion with support. The physician then squeezes the distal muscle belly and observes for supination of the forearm. Lack of supination is supporting evidence for tendon rupture. ==Causes==

Biceps tendon rupture may occur in patients with pre-existing rotator cuff tears or impingement syndromes, during athletic activities, or in the context of overuse, aging, or the use of corticosteroids. Proximal tendon rupture The most common tendon to be ruptured is the proximal tendon of the long head. Distal tendon rupture The mechanism of injury for a distal tendon rupture is forced contraction under eccentric load. A few examples of forced contraction under eccentric load include mixed-grip deadlifts (one forearm pronated and the other supinated, putting the biceps under greater load), preacher curls, and the "kingsmove" technique in armwrestling. Distal tendon ruptures are more common in males than females. Distal tendon tuptures occur more frequently in the dominant arm. ==Treatment==

Acute rupture of the distal biceps tendon can be treated nonoperatively with acceptable results, but because the injury can lead to 30% loss of elbow flexion strength and 30-50% loss of forearm supination strength, surgical repair is generally recommended. Complete distal biceps tears are commonly treated with re-attachment of the biceps tendon to its native insertion on the tuberosity of the radius using bone tunnels, suture buttons, or suture anchors. Proximal ruptures of the long head of the biceps tendon can be surgically addressed by two different techniques. Biceps tenodesis includes the release of the long head of the biceps tendon off of its insertion on the glenoid and re-attachment by screw or suture anchor fixation to the humerus. Biceps tenotomy consists of a simple release of the long head of the biceps without reattachment to the humerus, allowing the tendon to retract into the soft tissues of the proximal upper arm. Treatment of a biceps tear depends on the severity of the injury. The muscle will usually heal over time with no corrective surgery. Applying cold pressure and using anti-inflammatory medications will ease pain and reduce swelling. More severe injuries require surgery and post-op physical therapy to regain strength and functionality in the muscle. Corrective surgeries of this nature are typically reserved for elite athletes who rely on a complete recovery. Older patients will be treated by long head bicep tenotomy almost without exception. ==Prognosis==

Prognosis is dependent on the site of tendon rupture. A few reviews have shown that return to activity is independent of surgical approach, athlete age, steroid use, and rehabilitation program. ==References==