Distal Biceps Provocation Test

Caekebeke, Pieter; Schenkels, Eva; Bell, Simon; Riet, Roger van

doi:10.1016/j.jhsa.2020.12.012

Cited by 16 publications

(10 citation statements)

References 6 publications

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“…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.…”

Section: Discussionmentioning

confidence: 98%

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

Melkebeke

Brauns

Bekerom

et al. 2022

The Journal of Hand Surgery

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Section: Discussionmentioning

confidence: 98%

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

Melkebeke

Brauns

Bekerom

et al. 2022

The Journal of Hand Surgery

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“…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. Caekebeke et al 3 introduced the biceps provocation test for partial ruptures and tendinitis, with a sensitivity and specificity of both 100%. This test includes 2 parts: resisted flexion of the elbow with the forearm supinated and with the forearm pronated.…”

Section: Discussionmentioning

confidence: 99%

Distal Biceps Tendon Ruptures: Diagnostic Strategy Through Physical Examination

et al. 2022

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Background: Distinguishing a complete from a partial distal biceps tendon rupture is essential, as a complete rupture may require repair on short notice to restore function, whereas partial ruptures can be treated nonsurgically in most cases. Reliability of physical examination is crucial to determine the right workup and treatment in patients with a distal biceps tendon rupture. Purposes: The primary aim of this study was to find a (combination of) test(s) that serves best to diagnose a complete rupture with certainty in the acute phase (≤1 month) without missing any complete ruptures. The secondary aims were to determine the best (combination of) test(s) to identify a chronic (>1 month) rupture of the distal biceps tendon and indicate additional imaging in case partial ruptures or tendinitis are suspected. Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: A total of 86 patients with anterior elbow complaints or suspected distal biceps injury underwent standardized physical examination, including the Hook test, passive forearm pronation test, biceps crease interval (BCI), and biceps crease ratio. Diagnosis was confirmed intraoperatively (68 cases), by magnetic resonance imaging (13 cases), or by ultrasound (5 cases). Results: A combination of the Hook test and BCI (ie, both tests are positive) was most accurate for both acute and chronic ruptures but with a different purpose. For acute complete ruptures, sensitivity was 94% and specificity was 100%. In chronic cases, specificity was also 100%. Weakness on active supination and palpation of the tendon footprint provided excellent sensitivity of 100% for chronic complete ruptures and partial ruptures, respectively. Conclusion: The combination of a positive Hook test and BCI serves best to accurately diagnose acute complete ruptures of the distal biceps tendon. Weakness on active supination and pain on palpation of the tendon footprint provide excellent sensitivity for chronic complete ruptures and partial ruptures. Using these tests in all suspected distal biceps ruptures allows a physician to refrain from imaging for a diagnostic purpose in certain cases, to limit treatment delay and thereby provide better treatment outcome, and to avoid hospital and social costs.

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“…Two clear examples in the lower limbs are the Achilles tendon and the gluteus medius, where compression occurs at the posterosuperior border of the calcaneus12 13 and the greater trochanter,16 17 respectively. Some examples in the upper limbs include the long head of the proximal biceps tendon (at the level of the humeral head and bicipital groove)18–21, the distal biceps tendon (at the level of the radial tuberosity),14 22 23 the extensor carpi radialis brevis tendon (at the level of the lateral epicondyle and the capitellum)24 25 and the supraspinatus tendon (at the level of the humeral head and greater tuberosity) 21 26–29. Internal compression, on the other hand, can also occur in the midsubstance because of the Poisson effect or torsion during tensile loading 30–32.…”

Section: Methodological Considerationsmentioning

confidence: 99%

Exploring the role of intratendinous pressure in the pathogenesis of tendon pathology: a narrative review and conceptual framework

et al. 2022

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Despite the high prevalence of tendon pathology in athletes, the underlying pathogenesis is still poorly understood. Various aetiological theories have been presented and rejected in the past, but the tendon cell response model still holds true. This model describes how the tendon cell is the key regulator of the extracellular matrix and how pathology is induced by a failed adaptation to a disturbance of tissue homeostasis. Such failure has been attributed to various kinds of stressors (eg, mechanical, thermal and ischaemic), but crucial elements seem to be missing to fully understand the pathogenesis. Importantly, a disturbance of tissue pressure homeostasis has not yet been considered a possible factor, despite it being associated with numerous pathologies. Therefore, we conducted an extensive narrative literature review on the possible role of intratendinous pressure in the pathogenesis of tendon pathology. This review explores the current understanding of pressure dynamics and the role of tissue pressure in the pathogenesis of other disorders with structural similarities to tendons. By bridging these insights with known structural changes that occur in tendon pathology, a conceptual model was constituted. This model provides an overview of the possible mechanism of how an increase in intratendinous pressure might be involved in the development and progression of tendon pathology and contribute to tendon pain. In addition, some therapies that could reduce intratendinous pressure and accelerate tendon healing are proposed. Further experimental research is encouraged to investigate our hypotheses and to initiate debate on the relevance of intratendinous pressure in tendon pathology.

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Distal Biceps Provocation Test

Cited by 16 publications

References 6 publications

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

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

Distal Biceps Tendon Ruptures: Diagnostic Strategy Through Physical Examination

Exploring the role of intratendinous pressure in the pathogenesis of tendon pathology: a narrative review and conceptual framework

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