Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Biceps Tendon Rupture

SYMPTOMS

There is acute onset of pain over the anterior part of the shoulder with a lump typically forming at the mid-biceps from the retracted muscle bulk (the ‘Popeye sign’). Usually the biceps longus tendon, originating from the anterior superior labrum, ruptures and the short biceps tendon originating at the coracoid is intact. This leaves some biceps function infact.

AETIOLOGY

This injury often occurs in middleaged or elderly athletes or after cortisone injections. The rupture can be partial, causing pain but no
lump. If complete, the sudden lump on the mid-biceps is typical.

CLINICAL FINDINGS

The typical deformation can be seen clearly on resisted elbow flexion. A proximal partial tear or subluxation gives a positive palm-up test.

INVESTIGATIONS

This is a clinical diagnosis. MRI or ultrasound is usually not required for the diagnosis but may be done to investigate associated injuries.

TREATMENT

Usually this injury is treated without surgery with gradual and progressive rehabilitation. Even though the long head of the biceps, subject to sufficient length and quality, can be re-inserted into the humeral head, the functional improvement maybe questionable. However, an associated, SLAP tear is not unusual and may require surgery.

REFERRALS

Refer to Dr Kevin Yip (+65 9724 1219) senior orthopaedic surgeon to determine the grade of injury and for consideration of surgery. Refer to physiotherapist to start a three month rehabilitation programme.

EXERCISE PRESCRIPTION

Most sports and activities can be maintained, such as cross-training, working-out and running. The specific rehabilitation  should aim at a full range of controlled motion, goodposture and thoraco-scapular control, followed by functional training.

EVALUATION OF TREATMENT OUTCOMES

Normal clinical symptoms and signs. The apprehension test should be negative. Functional strength, control and flexibility should be comparable with the other shoulder.

DIFFERENTIAL DIAGNOSES

Associated injuries must be ruled out. Due to its origin at the anterior superior labrum, a SLAP tear, with or without impingement, may complicate the situation and require surgery.

PROGNOSIS

Good-Fair, depending on associated injuries.

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