1. BICEPS
RUPTURE
Supun Dhanasekara
Group no 04

2. The biceps,
is a two-headed muscle that lies on the upper arm between the shoulder and the
elbow.
Both heads arise on the scapula and join to form a single muscle belly which is
attached to the upper forearm.

3. • Short head: coracoid process of the scapula.
Long head: supraglenoid tubercle
• Artery Brachial artery
• Nerve Musculocutaneous nerve
Action
• Flexes elbow
• flexes and abducts shoulder
• supinates radioulnar joint in the forearm

4. What is a biceps rupture?
•A biceps rupture is a condition characterized by complete
tearing of one or more tendons or muscle bellies of the
biceps muscle.
•Rupture of the biceps tendon often occurs after a sudden
contraction of the biceps with resistance to flexion and
supination of the forearm.
• intrinsic degeneration of the tendon release and frictional
wear of the tendon belly may have an impact.

5. Bicep Tendon Ruptures
• Proximal biceps tendon rupture:
This is when one of the two biceps tendons in the shoulder is torn away from
the bone.
Sudden shoulder pain and an odd-shaped bulge in the biceps are symptoms.
• Distal biceps tendon rupture:
A tear of the biceps tendon at the forearm is unusual.
Sudden pain over the front of the elbow and forearm weakness are symptoms.

6. Proximal biceps tendon rupture
• When the proximal biceps tendon ruptures, the muscle moves
towards the elbow and becomes a big ball of muscle called the
Popeye muscle.
• A rupture of the distal biceps tendon occurs around the elbow joint
and usually occurs in men.
• A proximal rupture of the biceps tendon can be left alone especially in
elderly. However, a distal rupture of the biceps tendon should be
repaired.

7. Distal biceps tendon rupture
•Rupture typically occurs in athletes such as body builders or in
people who perform manual labour.
•Rupture of the tendon involves flexion of the elbow against
resistance with eccentric loading and sudden tearing of the
tendon.
•The patient will feel a pop with pain, swelling, and weakness of
the elbow.
• The biceps muscle may retract into the upper arm causing a
bump or “Popeye” sign.

8. Predisposing factors
Age. Older people have put more years of wear and tear on their
tendons than younger people.
Heavy overhead activities.
Shoulder overuse.
Smoking. Nicotine use can affect nutrition in the tendon.
Corticosteroid medications. Using corticosteroids has been linked to
increased muscle and tendon weakness.
Gender. Men suffer of biceps rupture more commonly than women,
but this difference may result primarily from vocational or
avocational factors.

9. SIGN AND SYMPTOM
• Sudden sharp acute pain in the upper arm
• Tenderness
• Weakness
• Sometime an audible pop or snap
• Bicep muscle cramp
• Bruising from the middle of the upper arm down
to ward the elbow
• Difficulty turning the arm palm up or palm down a bulge in the upper
arm above the elbow
• ("Popeye Muscle") may appear, with a dent closer to the shoulder.

10. Examination
• weakness of flexion and supination.
• Biceps will migrate proximally (Popeye sign).
• Hook test
Hook test
• A complete biceps tendon tear is detected by performing the hook test.
• Supinate the flexed elbow and palpate the tendon from the lateral side.
• If there is no tendon that can be hooked with the finger, then this is an
abnormal hook test, indicating the tendon ruptured distally.
• The patient will lose 40% of supination and 30% of flexion.

11. Hook Test

13. Investigation
• X ray

14. Ultrasound

15. MRI

16. Differential Diagnosis
Acromioclavicular Joint Separations
Gout
Rotator Cuff Disease
Septic Arthritis

17. MEDICAL MANAGEMENT
CONSERVATIVE
• NSAID
• Ice
• Rest
• Physical therapy
SURGICAL
• Incision
• Tenodesis
• acromioplasty

18. PHYSIOTHERAPY AND REHABILITATION MANAGEMENT
This choice of treatment the strength is 20% lower then before.
The treatment takes 4-6 weeks 2-3 times in a week
Phase1: acute phase
Week 1
• Clinical modalities as needed
• Glenohumeral ROM
- apply appropriate joint mobilization to restrictive capsular tissues
- implement wand stretching as indicated
- supplement with home program
- cross-arm stretch
- sleeper stretch
- Early scapular strengthening
- begin scapular stabilization with instruction in lower trapezius facilitation
Nonoperative Rehabilitation

19. phase 2: subacute phase, early strengthening
Week 2
• Continue with modalities and ROM.
• Begin rotator cuff strengthening
- sport cord internal/external rotation in 30° abductee
- sport cord low rows ( prone, scapular plane abduction
(<90°), celling punch, biceps and triceps)

20. phase 3: advanced strengthening
Week 3
• continue with strengthening
- resisted PNF patterns
- sport cord bear hug
- sport cord reverse fly
- sport cord IR/ ER at 90° abduction for neuromuscular re- education
- push-up progression
- begin 2- arm plyometric exercises advancing to 1-arm exercises
- weight training

21. • phase 4: return to activities
week 4
• continue with program
• re-evaluation with physician and therapist
• advance to return-to-sport program, as motion and strength allow

22. postoperative (tenotomy) rehabilitation
The operation is often carried out by young people or people who have a hard work, like
a carpenter, port worker,… etc.
These people need a maximal supination strength.
phase 1: passive
• pendulums to warm-up
• passive ROM
week 1
• full passive elbow flexion/ extension
• full passive forearm supination/pronation
• full passive shoulder ROM
• seated scapular retractions
• phase 2: active
• pendulums to warm-up
• active ROM, with terminal stretch to prescribed limits

23. Phase 2: active
week 2
• full active shoulder ROM, lawn chair progression
• active elbow flexion/ extension
• full ROM allowed
• active forearm supination/pronation
• full ROM allowed

24. phase 3: resisted
• pendulums to warm-up and continue the program
week 3
• sport cord internal/ external rotation at 30° abduction
• Prone I,T,Y,W
• Sport cord standing forward punch
• Sport cord low rows
• Sport cord bear hugs
• Biceps curls
• Resisted supination/pronation

25. • Phase 4 : weight training
Week 4
Keep hands within eyesight, keep elbows bent, minimize overhead
activities
Return to activities
- Computer after 1-2 weeks
- Golf after 4 weeks
- Tennis after 8 weeks