Distal biceps tendon ruptures: more efficient diagnostics for a better outcome


Distal biceps tendon; physical examination; diagnostic imaging; musculoskeletal ultrasound

Published online: May 03 2022


Miguel Deschrijver, Arne Hautekiet, Adelheid Steyaert, Martine De Muynck, Els Luypaert

From the Physical and Rehabilitation Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium


Distal biceps tendon ruptures are a rare pathology, but can have significant functional repercussions. Rapid, accurate diagnosis and treatment are es- sential for a favorable prognosis.

During the diagnostic process of distal biceps tendon ruptures, several problems can emerge.

An answer to the following clinical questions is given based on an extensive literature review.

– Which clinical tests are the most sensitive/ specific for clinical examination?
– Can ultrasound evaluation of the distal biceps tendon be optimized?
– Is ultrasound an equivalent alternative to MRI in the diagnosis of distal biceps tendon injuries?

An extensive literature search was conducted through Pubmed and Embase. The search strategy was developed systematically in the Medline data- base (PubMed interface), using medical subject headings as well as free text words.

A standardized clinical examination of the distal biceps tendon consisting of the Hook test, the Passive Forearm Pronation Test and the Biceps Crease Interval test has a high accuracy for correct diagnosis of full-thickness ruptures. Furthermore, Cobra sign, Supinator view and Pronator view give an additional value to the standard ultrasound examination of the distal biceps tendon. Finally, ultrasound can be considered a trustworthy and cost-effective alternative to MRI in evaluation of distal biceps tendon ruptures.