A novel clinical test for partial tears of the distal biceps brachii tendon: The TILT sign

Abstract

Partial tears of the distal biceps brachii tendon are rare. A complete tear of the distal biceps brachii tendon is readily diagnosed on the basis of history and physical examination and has a well-described clinical presentation of acute pain in the antecubital fossa, localized tenderness, swelling, palpable defect, positive hook test, and weakness in forearm supination and elbow flexion. Partial tears, on the other hand, can present more subtly and remain a diagnostic challenge. We present a novel physical examination technique that utilizes the rotational anatomy of the radius. The patient's forearm is passively supinated and pronated with the elbow flexed to 90° while the examiner firmly palpates the dorsal forearm overlying the radial tuberosity. The tuberosity presents itself beneath the examining fingers only in full forearm pronation. A positive test is indicated by tenderness over the radial (or lateral) aspect of the tuberosity (TILT sign) only in full forearm pronation, and not in supination. We have found this diagnostic test to be 100% sensitive for diagnosing partial distal biceps brachii tendon tears over the last five years during which it has been in use. Representative example cases are presented. A positive TILT sign indicates a diagnosis of partial tear of the distal biceps brachii tendon. This simple diagnostic maneuver could facilitate earlier detection of these injuries. Clin. Anat. 31:301-303, 2018. © 2017 Wiley Periodicals, Inc.

Evaluation of MRI Signal Changes of the Distal Biceps Tendon in Asymptomatic Patients

“…Clinical investigation of partial biceps tendon ruptures, bicipital bursitis, and tendinosis remains challenging. In recent years several clinical tests have been reported to aid in the clinical diagnosis (Harasymczuk, et al, presented at the ESSE-SECEC Virtual Meeting of the September 9, 2020) 11,12 As the MRI investigations in the present study were collected starting in 2012, these tests were not yet common knowledge and this has influenced the clinical investigation of caregivers not specialized in elbow pathology.…”

Distal Biceps Tendon Ruptures: Diagnostic Strategy Through Physical Examination

“…During the inclusion period of our study, 2 novel tests for partial ruptures and tendinitis were published. Shim and Strauch 23 presented a novel clinical test for partial tears of the distal biceps tendon, the TILT sign. This test, however, does not add to our study since it is performed exactly the same way as we performed palpation of the radial tuberosity.…”

Is the flexion-abduction-supination magnetic resonance imaging view more accurate than standard magnetic resonance imaging in detecting distal biceps pathology?

“…Diagnosis is difficult because the symptoms and clinical examination are often vague and nonspecific. 1,3,9,12,13 The literature has shown MRI of the elbow to be a useful tool in the diagnosis of distal tendon pathology. 4,6 However, most studies have evaluated complete ruptures of the distal biceps tendon.…”

“…8,11 However, for a complete tear with an intact lacertus fibrosus, a partial tear, tendonitis, or bursitis, the clinical image may be less obvious. 1,3,9,12,13 Patients often complain of pain in the antecubital region, exacerbated by activity. Biceps strength is usually good, and the findings of resistance tests may be negative.…”