Best Practice Case Studies-Distal Biceps Rupture

Video Transcription

Hi, I'm Chris Fulmer. I'm one of the faculty members for the Stanford O'Connor Sports Medicine Fellowship.  In this case, we are presented with a patient who has bilateral distal biceps ruptures.  This is a very unique presentation in that typically you'll see this in only unilateral injury. With this type of injury, prompt assessment is critical,  as delayed in diagnosis can dramatically influence the outcomes for that patient. Usually what I'll do as I start my exam is I'll perform the hook test.  Today I'm going to demonstrate only on one side, but I would usually do this on both arms simultaneously.  So to do this, I'll use my thumb, and I'll reach into the antecubital fossa, and I'll hook onto the distal biceps tendon and really kind of try to wrap my thumb tip around it.  If it's indistinct, you can have the patient give you a little bit of counter pressure with their palm, and that will make the tendon become more prominent.  By comparing both sides simultaneously, you can assess for even subtle changes or subtle differences  in the prominence of the tendon, which may help you detect even subtle ruptures or tears of the distal biceps tendon.  The other components to this exam that will be important would be performing resisted elbow flexion. So you can just do that by pushing up against and see if there's pain.  Again, palpating the distal biceps tendon simultaneously to assess for any gapping there.  And then lastly, since there are multiple flexors of the elbow, I think it's important to also test the biceps' other primary function, which is supination of the forearm.  So to do this, I'll maximally supinate the forearm and then have them try to go into pronation while I'm resisting.  Pain at the distal biceps area or not feeling the distal biceps tendon become taut would be indications that you could have a distal biceps rupture.

Video Summary

In this presentation, Chris Fulmer, part of the Stanford O'Connor Sports Medicine Fellowship, discusses diagnosing bilateral distal biceps ruptures, a rare bilateral occurrence typically seen unilaterally. Prompt assessment is critical to prevent poor outcomes. Fulmer emphasizes using the hook test to assess the distal biceps tendon, by wrapping the thumb in the antecubital fossa and applying counter pressure if needed. Comparing both arms is key to detecting subtle differences. He also highlights the importance of evaluating resisted elbow flexion and forearm supination to identify tendon rupture symptoms like pain or lack of tension.

Meta Tag

Edition 2nd Edition

Related Case 2nd Edition, CASE 07

Topic Elbow and Forearm

Keywords

2nd Edition, CASE 07

2nd Edition

Elbow and Forearm

bilateral distal biceps ruptures

hook test

elbow flexion

forearm supination

tendon rupture