IS Case 187: Biceps tendon rupture

Samuel Madoff, MD

Imaging Sciences URMC 2008
Publication Date: 2009-05-22


A 51-year-old male presented after a racquetball injury with elbow pain and swelling.


Biceps tendon rupture


Rupture of the distal biceps tendon is infrequent, representing less than five percent of biceps injuries overall. The vast majority of injuries occur proximally, usually involving the long head of the biceps.

The mechanism of injury is forced extension of a flexed forearm. Ancillary predisposing factors include muscle or tendinous weakening due to repetitive motion or inflammation.

Upon presentation, the majority of biceps ruptures are diagnosed clinically. Helpful signs include limited forearm flexion, a mass in the arm (“Popeye” sign) and antecubital ecchymosis.

Magnetic resonance imaging is helpful for surgical planning: defines the extent of the tear, reveals the quality of the tendon edges and demonstrates degree of retraction. Findings include a fluid-filled tendon sheath, absence of the tendon distally, an antecubital fossa mass and muscle edema and/or atrophy.

Typical treatment for biceps rupture is surgical repair with insertion of the tendon at the apex of the radial tuberosity or tenodesis.


  1. # Falchook FS, Zlatkin MB, Erbacher GE, Moulton JS, Bisset GS, Murphy BJ. Rupture of the distal biceps tendon: evaluation with MR imaging. Radiology. 1994 Mar;190(3):659-63. [PMID: 8115606]
  2. Manaster BJ, Roberts CC, Andrews cL, Petersilge CA, Crim J. Biceps tendon rupture. IN: Diagnostic and Surgical Imaging Anatomy: Musculoskeletal. Lippincott Williams & Wilkins: 2006.

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