Question
A 26 year old male presented to emergency with rupture of muscle as shown in the image,during heavy weight lifting.Sign used for evaluation of this condition is:
A. Jerk test
B. Apprehension Maneuvre
C. Popeye test
D. Adson’s Maneuvre
Show Answer
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Correct Answer » C Explanation |
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Ans:C. Popeye test
Anatomy of Biceps muscle:
- At its proximal attachment, the biceps has 2 distinct tendinous insertions on the scapula from its long and short heads.
- The short head arises from the coracoid process with the coracobrachialis, while the long head originates from the supraglenoid tubercle and passes over the humeral head within the capsule of the glenohumeral joint.
- The biceps muscle then continues down the arm within the intertubercular groove, covered by a synovial outpouching of the joint capsule.
- The 2 muscle bellies unite near the midshaft of the humerus and attach distally on the radial tuberosity.
- The biceps receives innervation via the musculocutaneous nerve (C5, C6).
Rupture of Biceps tendon
- Ruptures of the proximal biceps tendon make up 90-97% of all biceps ruptures and almost exclusively involve the long head.
- The injury is experienced most commonly by individuals aged 40-60 years with a history of shoulder problems, secondary to chronic wear of the tendon.
- Younger individuals may rupture the biceps tendon following a traumatic fall, during heavy weightlifting, or during sporting activities.
- Distal biceps rupture (at the tendon insertion) is rare, occurring in sports such as weightlifting.
Clinical Features:
- Typically, the patient reports that they heard something “snap” in the shoulder whilst lifting.
- Bruising over the proximal anterior arm
- Popeye sign’: an obvious swelling in the arm caused by the contracted biceps muscle which does not move with supination
- Ludington’s test (hands clasped behind the head and the biceps muscles flexed) is useful to look for asymmetry in muscle bulk between both biceps
- Tenderness on palpation may be felt along the course of the biceps tendon and muscle belly
- Assess power of the upper limb and range of movement (ROM) of the shoulder and elbow
- Proximal biceps rupture results in approximately 20% forearm flexion loss but more significant loss of forearm supination
Management :
- Proximal tendon rupture:the initial management should be the standard RICE (rest, ice, compression and elevation) approach combined with physiotherapy when the acute swelling has settled.
- Distal tendon rupture always require urgent surgical repair.
