Bicep Tear Test

What Is a Bicep Tear?

A bicep tear or bicep tendon tear is a musculoskeletal condition characterized by partial or complete tearing of one of the tendons anchoring the biceps muscle to the shoulder or elbow. This tear can occur proximally, at the superior aspect of the bicep near the shoulder, or distally, at the inferior part near the elbow. While proximal tendon tears are more frequently observed, distal tendon tears, though less common, often require surgical intervention due to the bicep's role in forearm supination and elbow flexion.

The etiology of a  is multifactorial. Acute tears often result from sudden, forceful movements or heavy lifting without proper technique or conditioning. Chronic tears, on the other hand, are generally attributed to long-term degenerative changes due to aging or overuse, particularly in individuals frequently engaged in repetitive overhead activities or sports that involve forceful, repeated throwing motions.

The biceps brachii, with its two-headed anatomical structure, is critical to the biomechanical functions of the arm, providing stability to the glenohumeral and elbow joints and facilitating movements such as flexion and supination. Consequently, a tear in the bicep tendon can significantly compromise upper limb functionality and quality of life.

Given the clinical implications, prompt diagnosis and management are paramount. Clinical tests like the Yergason's, Ludington's, Biceps Squeeze, and Hook Tests are often used in differential diagnosis. It is incumbent upon healthcare professionals to have a comprehensive understanding of these diagnostic tests to ensure timely and appropriate management of this condition.

How Does It Work?

To administer this assessment properly and accurately, follow the steps below:

Step 1: Patient Information

• Begin by recording the patient's information. This includes the patient's name, age, gender, occupation, physical activities, and previous injury history.
• Discuss and note down the patient's area of pain or discomfort.

Step 2: Conducting the Yergason's Test

• In a seated or standing position, have the patient flex their elbow to 90 degrees with the thumb up.
• Ask the patient to supinate the forearm against resistance.
• If the patient experiences pain or a 'pop' in the bicep groove, score the test as 1. If not, score it as 0.

Step 3: Conducting the Ludington's Test

• In a seated or standing position, have the patient clasp both hands behind the head and contract the biceps.
• Observe and palpate both biceps tendons.
• If movement or tension is absent on the affected side when the biceps muscle is contracted, score the test as 1. If not, score it as 0.

Step 4: Conducting the Biceps Squeeze Test

• Have the patient flex their elbow to 60-80 degrees in a seated or standing position.
• Apply pressure to the biceps muscle.
• If there is an absence of forearm supination or elbow flexion when pressure is applied to the biceps muscle, score the test as 1. If not, score it as 0.

Step 5: Conducting the Hook Test

• Have the patient flex their elbow to 90 degrees in a seated or standing position.
• Try to 'hook' your index finger under the bicep tendon from the lateral side.
• If it's impossible to 'hook' the index finger under the bicep tendon, score the test as 1. If not, score it as 0.

Step 6: Scoring and Interpretation

• Sum up the scores from all the tests.
• A score of 0 for a test indicates a negative sign (no pain or discomfort during the test). In contrast, a score of 1 indicates a positive sign (pain or discomfort reproduced during the test).
• A score of one on two or more tests indicates a positive finding for a bicep tear.

Step 7: Additional Notes

• Make sure to take any additional notes regarding the patient's condition, including their reactions to each test and any other symptoms they may be experiencing.
• This can help when discussing the results with the patient and deciding on further diagnostic procedures and treatment options.

Scoring Guide

Scoring the Bicep Tear Test is a straightforward process. Each test (Yergason's, Ludington's, Biceps Squeeze, and Hook's) is scored 0 or 1. A score of 0 indicates a negative sign, meaning the patient experienced no pain or discomfort during the test. A score of 1 indicates a positive sign, meaning the patient experienced pain or discomfort during the test. After conducting all four tests, sum up the scores.

A total score of one on two or more tests indicates a positive finding for a bicep tear. It's important to note that while this scoring guide provides a strong indication of a bicep tear, it should be used in conjunction with other diagnostic tools and clinical judgment for a comprehensive assessment of the patient's condition.

When Would You Use This Test?

Recognizing the right time to use the Bicep Tear Test can significantly enhance your diagnosis's accuracy and the treatment plan's effectiveness. As a healthcare professional, your expertise in identifying the symptoms and the need for this test is crucial.

• Initial Consultation: During an initial consultation, if a patient presents with shoulder pain, especially in the bicep region, or reports difficulty with normal arm functions, the Bicep Tear Test is a valuable tool to conduct an early assessment.
• Physical Examination: The test is used during physical examinations when patients report persistent bicep pain or when a bicep tear is suspected due to symptoms like a sudden sharp pain in the upper arm, an audible snap, or visible bulging of the bicep muscle.
• Post-Injury Assessment: If a patient has experienced an injury involving the arm, the test can be used to assess the extent of damage to the biceps tendon and to aid in determining the appropriate course of treatment.
• Progress Monitoring: This test can be utilized regularly to monitor healing progress and response to treatment for patients undergoing rehabilitation for a bicep tear.

The Bicep Tear Test is a versatile tool used in various contexts, from the initial consultation to monitoring rehabilitation progress. Recognizing the appropriate situations for its use will enable a more accurate and efficient assessment of potential bicep tears.

Benefits

Quick and Efficient

The Bicep Tear Test is a quick and efficient way to assess for a potential bicep tear. It can be conducted within minutes, making it a practical tool in busy clinical settings.

Non-Invasive

As a physical examination, it is non-invasive and requires no special equipment, making it a comfortable patient experience and easily implementable by healthcare professionals.

Cost-Effective

Given that it doesn't require any special equipment or tools, the Bicep Tear Test is a cost-effective method of initial assessment or ongoing monitoring.

Immediate Results

The test provides immediate results, allowing for prompt decision-making regarding further diagnostic tests or the initiation of treatment plans.

Versatile

The Bicep Tear Test can be used in various healthcare settings, including hospitals, clinics, physiotherapy centers, and sports medicine facilities.

Research & Evidence

The Bicep Tear Test comprises various individual tests that have been researched extensively and have demonstrated reliability in the clinical assessment of bicep tendon pathology.

Yergason's Test, for instance, was initially described by Dr. Sam Yergason in 1931 as a method to identify biceps tendon instability or transverse humeral ligament tears. Over the years, it has proven to be a reliable test in determining biceps tendon pathology, especially in the setting of rotator cuff tears.

Similarly, the Hook Test, first described by O'Driscoll et al. in 2007, is a susceptible and specific clinical test for diagnosing distal biceps tendon ruptures.

Ludington's and the Biceps Squeeze Test are also recognized in the medical community for their utility in diagnosing bicep tears and other conditions.

It's important to note that while these tests have solid empirical support, they should be used in conjunction with a thorough clinical examination and patient history. They are part of a comprehensive approach to accurately diagnosing and managing bicep tears.

References

1. Yergason RM. Supination sign. J Bone Joint Surg Am. 1931;13(1):160.
2. O'Driscoll SW, Goncalves LB, Dietz P. The hook test for distal biceps tendon avulsion. Am J Sports Med. 2007;35(11):1865-1869.
3. Kibler WB, Sciascia A, Moore S. An acute rupture of the biceps tendon. Am J Sports Med. 2012;40(2):484-489.