Today I talk about Biceps Ruptures and Biceps Tendinitis. I have some great videos that are linked in these show notes. Be sure to know the importance of identifying distal versus proximal biceps ruptures.
Episode 021- Biceps Ruptures and Biceps Tendinitis
Let’s start with some functional anatomy:
- The biceps are both an elbow flexor and supinator of the forearm (My opinion, a bigger supinator)
- Short head attaches at the coracoid process and pulls in a relatively straight direction. Almost never torn.
- Long head of the biceps travels through the bicipital groove, over the humeral head and attaches at the supra-glenoid tubercle.
- The long head is both an intra and extra-articular tendon, a big pain generator and is more often torn because of impingement and mechanical disadvantage.
- The distal biceps tendon inserts onto the radial tuberosity. A distal tear will be more functionally hindering then a proximal tear. Identify it and refer to an Orthopedist quickly.
Pointers to remember
- Biceps ruptures bruise a lot (unlike rotator cuff tears)
- The long head of the biceps is a humeral head depressor. I like to strengthen it early after rotator cuff surgery if tenotomy or tenodesis was not performed. This is the position I like to strengthen it in. The cuff doesn’t have to hold the humerus into ER this way.
- When trying to differentiate between rotator cuff tendinitis/impingement and bicipital tendinitis, palpate the biceps tendon in the bicipital groove and then follow the tendon down to the musculo-tendinous junction. Biceps tendinitis will commonly hurt through this whole area.
- The Hook Test is very accurate at identifying a distal biceps tendon tear. Here is a link to a video of how to perform the Hook test: https://youtu.be/7fcDs0H3-xo
- This is a video of how I like to assess biceps tendon injuries on a patient with an actual tear: https://youtu.be/JqfnPpfHwcg
- Check out this links of an explanation of how to assess biceps injuries on a man with an old biceps rupture: https://www.facebook.com/groups/1785367494811586/permalink/1970009073014093/
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In Good Health,
Paul Marquis PT