This _ presents with upper arm pain and exam findings suspicious for a biceps tendon rupture. Differential includes bursitis, muscle strain, partial tear, fracture, and elbow pathology. Neurovascularly intact distal to the injury.

Plan: plain films, urgent orthopedic referral, pain control, reassessment, anticipating discharge

 

PEARLS:
– Classic mechanism for biceps tendon rupture:
— FOOSH – proximal rupture
— Elbow forced straight against resistance – distal
– Exam: “popeye’s sign” from rupturing of the long head of the biceps. Probably will be able to still flex a little if it’s proximal.
– If they have a distal rupture, they will have marked ecchymosis over the AC and marked weakness on flexion
– Hook test: you should be able to get about 1 cm under the biceps tendon with your finger as a ‘hook’

• Proximal ruptures are usually managed nonop; distal ruptures require near-term urgent ortho f/u.