Biceps Rupture

Although not as common, the biceps muscle or tendon may also rupture. When this happens, the belly of the muscle is seen in a position more distal than is normal. 

When a tendon lesion is suspected, specific resisted movements must be checked. Due to its superficial position, the distal biceps tendon can easily be palpated during resisted flexion while keeping the elbow 90 flexed and supinated. The rupture of this tendon is typically associated with retraction of the muscle into the arm, where it can be appreciated as a lump (see Sect. 8.5.1.1). Nevertheless, the retracted muscle belly can be difficult to detect in obese patients or when local swelling and pain... 

An early diagnosis of distal biceps tendon rupture is important because surgical outcome is improved in patients treated in the first weeks after trauma before the occurrence of tendon adhesions, degenera-... 

Fig. 8.26a,b. Distal biceps tendon tear physical findings. Photographs of two different patients who underwent a subacute and b chronic complete rupture of the distal hiceps tendon. In a, the patient injured his left tendon while attempting to lift a heavy object. He presented with hemorrhagic skin over the medial elhow and proximal forearm and with a proximal lump (arrowheads) in the anterior aspect of the arm related to the retracted muscle. In b, the patient was a competitive body-builder who refused surgical repair of the ruptured tendon. Note the defect (arrowhead) in the anterior left arm due to the retracted muscle in comparison with the right side... 

Fig.8.28a-c. Complete rupture of the distal biceps tendon, a Long-axis 12-5 MHz US image obtained proximal to the elbow joint with b,c correlative transverse T2w SE MR images acquired at the levels (vertical white bars) indicated in a show the retracted edge (arrows) of the distal biceps tendon (dbt) with hypoechoic fluid (asterisks) filling the gap... 

Fig. 8. 30a-d. Partial rupture of the distal biceps tendon, a Long-axis and b short-axis 12-5 MHz US images obtained at level distal to the elbow joint with c, d correlative transverse Tlw SE MR images demonstrate a thickened and heterogeneous tendon (arrows) inserting on the radial tuberosity (asterisk)... 

Agins HJ, Chess JL, Hoekstra DV et al (1988) Rupture of the distal insertion of the biceps brachii tendon. Clin Orthop 234 34-38... 

Falchook FS, Zlatkin MB, Erbacher GE et al (1994) Rupture of the distal biceps tendon evaluation with MR imaging. Radiology 190 659-663... 

Lin J, Jacobson JA, Fessell DP et al (2000) An illustrated tutorial of musculoskeletal sonography. II. Upper extremity. AJR Am J Roentgenol 175 1071-1079 Lozano V, Alonso P (1995) Sonographic detection of the distal biceps tendon rupture. J Ultrasound Med 14 389-391... 

In the posterior thigh, the most common muscle to tear is the biceps femoris (long head involved in approximately 85% of all cases of hamstring injuries), probably because this muscle contains a high proportion of type 2 fibers, plays an eccentric function and is intrinsically more inextensible due to its double origin from the femur and the ischial tuberosity (Garret 1990 Slavotineck et al. 2002). In a considerable number of cases (37%), the injury to the biceps femoris occurs in association with a semitendinosus strain, whereas the isolated rupture of the semitendinosus (30%) and semimem-... 

Fig. 13.34a-c Acute tear of the distal short head of the hiceps muscle in a soccer player, a Short-axis and b long-axis 12-5 MHz US images show a hypoechoic hematoma (arrow) located within the short head (SH) of the biceps femoris muscle. The overlying long head (LH) is normal, c Photograph of the posterior thigh reveals the ecchymotic skin (arrowhead) related to muscle rupture... 

Fig. 14.88a-c. Complete tear of the common peroneal nerve in a patient with previous knee dislocation, a Long-axis 12-5 MHz US image over the peroneal nerve in the popliteal fossa. The nerve has a wavy course and is characterized by abnormal thickened (arrowheads) and thinned (arrows) segments related to the interruption and laceration of the fascicles, b Transverse oblique 12-5 MHz US image over the lateral knee with c lateral radiographic correlation demonstrates abnormal hypoechoic tissue related to the avulsion of the biceps femoris tendon (arrows) from its insertion (open arrowhead) into the fibular head (FHj.Note the close relationship of the ruptured biceps with the torn nerve (white arrowheads). On the radiograph, a small fleck of bone (curved arrow) appears retracted proximally with the torn biceps tendon... 

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