152: BICEPS RUPTURE

CONDITION/DISORDER SYNONYMS

• Biceps distal tear

• Biceps proximal tear

ICD-9-CM CODES

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

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

ICD-10-CM CODES

• 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

PREFERRED PRACTICE PATTERNS

• 4D: Impaired joint mobility, motor function, muscle performance, and range of motion associated with connective tissue dysfunction

• 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation¹

KEY FEATURES

Description

• 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

Essentials of Diagnosis

• History and clinical examination

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

• Diagnosis of distal tear

  • Palpation of gap at the elbow

  • Manually testing supination strength compared with uninvolved side

  • Sudden event trauma

• Partial tears 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., biceps curls or activities with elbow flexion), eccentric force

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

• MRI to show both partial and complete tendon tears

General Considerations

• 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 ...