Bicipital Tendon Injuries Clinical Presentation

Updated: Jul 14, 2022
  • Author: John P Salvo, Jr, MD, MS; Chief Editor: Harris Gellman, MD  more...
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Bicipital tendon ruptures most commonly occur in the dominant extremity in men aged 40-60 years (average age, ~50 years). Patients often have a history of acute pain in the antecubital fossa and typically give a history of either lifting or holding something heavy with the elbow flexed immediately prior to the injury. Patients may or may not have a history of previous elbow pain. This pain, if present, may be related to tendon degeneration or a previous partial tear.

The acute pain is accompanied by deformity in the antecubital fossa due to tendon retraction. An obvious deformity indicates rupture of the tendon and the lacertus fibrosus. Some patients also have swelling, ecchymosis, or both in the antecubital fossa, typically over the medial proximal forearm. Initially, they may have weakness with flexion due to pain. This symptom may subside in a few days as the swelling decreases, but weakness with supination does not subside. If the tendon is completely ruptured but the lacertus fibrosis is intact, little deformity may be present.


Physical Examination

On examination, tenderness may be noted in the antecubital fossa, in addition to deformity due to the tendon retraction. If the lacertus fibrosus is not ruptured, the deformity is not as pronounced, but it can still be appreciated on comparison with the opposite extremity. The deformity is accentuated with resisted supination with the elbow in flexion.