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proximal-biceps-tendon-rupture

Proximal Biceps Tendon Rupture: Pathogenesis and clinical findings Author: Alyssa Federico Reviewers: Tara Shannon, Mehul Gupta, Yan Yu*, Gareth Ryan* * MD at time of publication Aging Decreased tendon strength from age- related changes in extracellular matrix Male gender Smoking Corticosteroid and fluoroquinolone use Shoulder Overuse Repetitive overhead sports like swimming & tennis Shoulder overuse injuries (rotator cuff tears, shoulder impingement, & tendonitis) place more stress on the proximal biceps tendon Repetitive microtrauma and inflammation of biceps tendon Compromised biceps tendon integrity from intra-tendinous collagen degeneration, disorientation, and thinning Increased involvement in physical labour and hobbies Impaired cell proliferation and healing after injury Exact mechanisms remain unclear Bicep tendon involved in shoulder stabilization, elbow flexion, and forearm supination Biceps muscle cannot contract with as much force when one head is detached Heavy lifting or fall on outstretched handà sudden tension in the proximal biceps tendon Proximal biceps tendon rupture Long head of proximal biceps tendon detaches from bony attachment on supraglenoid tubercle Audible “pop” at time of injury No tension to hold proximal bicep tendon head in place Proximal bicep tendon head retracts distally Biceps muscle fatigue and cramping Weakness in shoulder flexion, elbow flexion & supination Nerve damage (musculocutaneous nerve) during injury Local inflammatory response at site of injury Surrounding blood vessels damaged during injury Blood collection under skin surface Immediate bruising over rupture site Sudden and sharp pain at shoulder with initial injury Inflammatory response aggravates musculocutaneous nerve Swelling over rupture site + Speed test: affected elbow extended and forearm supinated. Shoulder flexed against resistanceàpain at bicipital groove + Neer test: on affected side, scapula stabilized while arm passively flexed and internally rotatedàpain at bicipital groove + Yergeson test: affected elbow flexed at 90° and forearm pronated. Forearm supinated against resistance àpain at bicipital groove “Popeye” deformity: mass in distal upper arm due to excessive retraction of biceps muscle distally, away from its origin Palpable gap between proximal biceps tendon and bicipital groove Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published April 20, 2022 on www.thecalgaryguide.com