Lost MSK

Question 1

Biceps tendon rupture

Answer 1

Epidemiology
Biceps ruptures are more common in men than women at a 3:1 ratio. 90% are proximal rutures

Mechanism of injury:
Proximal biceps long tendon ruptures: typically occurs when the biceps are lengthened and contracted and a load is applied. e.g. the descent phase of a pull-up.
Distal biceps tendon ruptures: Usually when a flexed elbow is suddenly and forcefully extended whilst the biceps muscle is contracted

Patients typically report the following symptoms/signs:
A sudden ‘pop’ or tear either at the shoulder (long tendon)
Rupture of the proximal tendon causes ‘Popeye’ deformity; this is when the muscle bulk results in a bulge in the middle of the upper arm
Rupture of the distal tendon can cause ‘reverse Popeye’ deformity but this is not a reliable sign.
Weakness in the shoulder and elbow typically follows including difficulty with supination

mx
The biceps squeeze test: If it is intact then a squeeze will cause forearm supination
Musculoskeletal ultrasound by a skilled clinician
For suspected long head biceps tendon rupture there is little role for further imaging given the conservative management
distal rupture- emergency MRI

MX- conservative w/ RICE- pain should subside in a few weeks
can be refered to surgery in younger pts,