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  • Biceps distal tear
  • Biceps proximal tear

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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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  • 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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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 exam
  • 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 weightlifting (i.e., 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 4th decade of life

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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 recoiled, shortened tendon
  • Distal tear will result in gap at elbow due to severed tendon

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Functional Implications

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  • For proximal long head tear, mild weakness can persist in elbow flexion
  • For distal tears, significant loss of supination ...

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