Biceps Tendon Rupture
What is it: The biceps tendon can rupture proximally (up by the shoulder) or distally (down by the elbow). Most commonly the biceps ruptures proximally, but a distal biceps rupture may present as "elbow" pain.
How does it present: The patient usually presents after abrupt onset of pain, and perhaps swelling and bruising in the antecubital fossa. The injury usually occurs after a flexion or supination event against force. It is more common in older men.
Common exam findings: On exam you may find swelling and ecchymosis in the region of the antecubital fossa. You may also be unable to palpate the biceps tendon in the antecubital fossa. When asked to flex the elbow against resistance, you may see the muscle belly of the biceps retract up the arm. Resisted flexion and supination strength will be decreased, although some flexion can still occur due to the brachialis and some supination can occur due to the supinator muscle.
Tests and treatment: X-rays may show an avulsion fracture off the radial tuberosity. If further imaging of the biceps is needed for diagnosis, an ultrasound or magnetic resonance imagine (MRI) may be indicated. To return function, treatment is generally surgical, so referral to orthopedics is appropriate.