Acute biceps brachii injuries

Abstract

Acute injuries to the biceps range in severity from mild strains and contusions to complete tendon and muscle belly ruptures. As with many muscles and tendons, injuries tend to occur during eccentric loading of the muscle, such as resisting a force attempting to extend the elbow and pronate the forearm. While distal biceps ruptures are more common, proximal rupture of the long head and more rarely the short head have also been reported. Proximal ruptures can result in a “popeye” deformity, while distal ruptures can be diagnosed on physical examination through the use of the hook test and occasionally the presence of a reverse “popeye” deformity. While plain films are generally negative, MRI or ultrasound can confirm either diagnosis. Complete ruptures of the long head of the biceps tendon may be asymptomatic, particularly in elderly patients and those with lower functional demands. Such injuries are frequently treated nonoperatively. Conservative treatment of complete distal ruptures is generally less favorable, with significant residual weakness and cosmetic deformity noted. Operative treatment is generally indicated, with the exception of the elderly and patients with low functional demands.