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Biceps Rupture Workup

  • Author: Gary L Branch, DO; Chief Editor: Milton J Klein, DO, MBA  more...
Updated: May 13, 2016

Imaging Studies

In most cases, proximal and distal ruptures can be detected on the basis of history and physical examination alone. The mechanism of injury, a history of pain and/or inflammation, and supportive physical findings (as discussed above) lead to a confident diagnosis in most patients. Several imaging studies can be employed as an extension of the physical examination to rule out other disorders from the lengthy list of possibilities.


Plain radiographs may reveal hypertrophic spurring or bony irregularities that increase the likelihood of biceps rupture and support a clinical suspicion of this diagnosis. Anteroposterior and axillary films are the most useful views for ruling out fractures in this setting.


Arthrography has been used for a long time to evaluate tendon ruptures, but it has several drawbacks, including the following:

  • Invasiveness
  • Need for experienced interpreters of rarely seen images
  • Ionizing radiation
  • Possible confusion with concomitant rotator cuff tears


Ultrasonography of the anterior shoulder can provide a useful and reliable evaluation in many cases and has previously been shown to be superior to arthrography for the examination of the biceps tendons. The use of diagnostic ultrasonography for musculoskeletal indications has received increasing attention.[1, 10, 14]

Studies have indicated that complete rupture or dislocation of the long head of the biceps can reliably be identified in this manner.[15, 16] (However, intra-articular or partial thickness tears, as well as degenerative changes, may be more difficult to detect with ultrasonography.[17] ) Smaller, more portable, and less expensive ultrasonography units have likely contributed to the increased use of ultrasonography in the office setting. Other advantages of this modality include the following:

  • Lack of ionizing radiation
  • Painless examination
  • Rapid interpretations
  • Dynamic imaging capability
  • Low cost

Potential disadvantages of ultrasonography include the following:

  • Limited ability to image the intra-articular portion of the tendon, which is the most frequent site of rupture
  • Can be more technically challenging and is highly operator dependent


Magnetic resonance imaging (MRI) provides the greatest anatomic detail from proximal to distal attachment[18] ; the major disadvantage is the higher cost of MRI compared with costs associated with other imaging modalities.


Histologic Findings

Histologic studies associated with tendon rupture repeatedly have revealed similar results. Nontraumatic tendon ruptures, including those of the biceps brachii, show evidence of advanced degeneration. Changes include hypoxic tendinopathy, mucoid degeneration, lipomatosis, and calcifying tendinopathy.[19] Often, evidence of reduced collagen fiber thickness, decreased crimp angle, and disrupted crimp continuity is also present in tendon rupture.

In symptomatic and asymptomatic patients with rupture (not limited to the biceps alone), a healthy tendon composition rarely, if ever, has been encountered. In contrast, nonruptured (control) tendon samples have demonstrated a much lower incidence of degenerative change in large study populations. Although the etiology of degenerative changes remains unclear, this group of subjects may be heterogeneous, with multiple factors at work.

Contributor Information and Disclosures

Gary L Branch, DO Staff Physician, Memorial Healthcare Center and Mid-Michigan Orthopedics

Gary L Branch, DO is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Osteopathic College of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.


J Michael Wieting, DO, MEd, FAOCPMR, FAAPMR Senior Associate Dean, Associate Dean of Clinical Medicine, Consultant in Sports Medicine, Assistant Vice President of Program Development, Division of Health Sciences, DeBusk College of Osteopathic Medicine; Professor of Physical Medicine and Rehabilitation, Professor of Osteopathic Manipulative Medicine, Lincoln Memorial University-DeBusk College of Osteopathic Medicine

J Michael Wieting, DO, MEd, FAOCPMR, FAAPMR is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, American Osteopathic Academy of Sports Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Aishwarya Patil, MD Physiatrist (Rehabilitation Physician), Vice Chair, Immanuel Rehabilitation Center

Aishwarya Patil, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, Association of Physicians of India

Disclosure: Nothing to disclose.

Chief Editor

Milton J Klein, DO, MBA Consulting Physiatrist, Heritage Valley Health System-Sewickley Hospital and Ohio Valley General Hospital

Milton J Klein, DO, MBA is a member of the following medical societies: American Academy of Disability Evaluating Physicians, American Academy of Medical Acupuncture, American Academy of Osteopathy, American Academy of Physical Medicine and Rehabilitation, American Medical Association, American Osteopathic Association, American Osteopathic College of Physical Medicine and Rehabilitation, American Pain Society, Pennsylvania Medical Society

Disclosure: Nothing to disclose.

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Biceps muscle and tendons
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