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Condition/Disorder Synonyms

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  • Biceps distal tear

  • Biceps proximal tear

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ICD-9-CM Codes

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  • 727.62 Nontraumatic rupture of tendons of biceps (long head)

  • 840.8 Sprains and strains of other specified sites of shoulder and upper arm

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ICD-10-CM Codes

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  • M66.829 Spontaneous rupture of other tendons, unspecified upper arm

  • S46.119A Strain of muscle, fascia, and tendon of long head of biceps, unspecified arm, initial encounter

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Preferred Practice Patterns

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Key Features

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Description

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  • Rupture of the biceps brachii tendon, either complete or partial.

  • Distal rupture will cause swelling, bruising, and a gap in front of elbow, created by absence of tendon.

    • - Avulsion of the tendon from the radial tuberosity

  • Proximal rupture will cause bulging, bruising, and gathering of the muscle ("Popeye" sign may indicate rupture).

    • - Avulsion of the long head of the biceps brachii from the superior rim of the anterior glenoid labrum

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Essentials of Diagnosis

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  • History and clinical examination.

  • Diagnosis of proximal tear is often easily visible with observation due to bulge left by deformed muscle ("Popeye sign").

  • Diagnosis of distal tear.

    • - Palpation of gap at elbow

    • - Manually testing supination strength compared with uninvolved side

    • - Sudden event trauma

  • Partial tears can be harder to diagnose and may require manually testing bicep muscle for signs of pain with activation of muscle.

  • Occurs from a sudden high force, typically with weight lifting (ie, bicep curls or activities with elbow flexion), eccentric force.

  • May arise from a repetitive type activity that leads to a gradual degeneration.

  • MRI can be used to show both partial and complete tendon tears.

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General Considerations

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  • History of repetitive motion, especially activities overhead.

  • Common in swimming, tennis, baseball, and with occupational activities involving repetitive or overhead activity due to microtrauma.

  • Smoking affects overall nutrition of tendon due to nicotine side effects.

  • Corticosteroid medications have been linked to decreased muscle and tendon strength.

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Demographics

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  • Predominately individuals involved in repetitive activities in sports or work.

  • Long head tears are typically seen in the fourth decade of life.

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Clinical Findings

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Signs and Symptoms

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  • Patient will describe an audible pop or snap associated with injury.

  • Sharp pain occurring suddenly in upper arm.

  • Ecchymosis, swelling, bulging of upper arm.

  • Pain and tenderness with palpation of shoulder and elbow.

  • Diminished strength of elbow flexion and supination.

  • Appearance of bulge ("Popeye muscle") with indentation closer to shoulder for proximal tear.

  • Distal tear will result in bulge in upper part of arm due to ...

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