The Biceps Crease Interval for Diagnosing Complete Distal Biceps Tendon Ruptures

Abstract

Complete distal biceps tendon ruptures require prompt surgical management for optimal functional and aesthetic outcome. The need exists for a valid and reliable diagnostic tool to expedite surgical referral. We hypothesized complete distal biceps tendon ruptures result in an objectively measurable anatomic landmark (the distance between the antecubital crease of the elbow and the cusp of distal descent of the biceps muscle, or the biceps crease interval), as a result of proximal retraction of the musculotendinous complex. We established normal biceps crease interval values and biceps crease ratios between dominant and nondominant arms in 80 men with no history of biceps injury (average age, 43 years). The mean (± standard deviation) biceps crease interval for dominant and nondominant arms was 4.8 ± 0.6 cm. The mean biceps crease ratio was 1.0 ± 0.1. We measured the biceps crease interval and biceps crease ratio on 29 consecutive patients presenting with a possible complete distal biceps tendon rupture. Using a diagnostic threshold of a biceps crease interval greater than 6.0 cm or biceps crease ratio greater than 1.2, the biceps crease interval test had a sensitivity of 96% and a diagnostic accuracy of 93% for identifying complete distal biceps tendon ruptures, making it a valid and reliable tool for clinicians to identify cases requiring urgent surgical referral.

Physical examination of the elbow, what is the evidence? A systematic literature review

“…The biceps crease interval (BCI) test uses the distance between the antecubital fossa and the start of the biceps curve, with 6.0 cm (2 SDs larger than in a control group) as a cut-off value 26 28. The biceps crease ratio (BCR) is an additional test that compares the biceps crease between the injured and non-injured arm 28. A combination of the hook test, PFP and BCI altered the sensitivity but dropped the specificity compared with separate tests 26.…”

Distal Biceps Tendon Rupture

“…The biceps crease interval is the distance between the antecubital crease and the distal edge of the biceps. A biceps crease interval of 6 cm, or a 20% increase compared to the unaffected arm, correctly diagnosed a complete distal biceps tendon rupture in 93% of cases in one small study (5). The biceps squeeze test is analogous to the Thompson test for Achilles tendon rupture.…”

“…Early referral is preferred because tendon retraction and scarring associated with chronic ruptures (>10 days) makes surgery more problematic and prone to complications (5,9). Complications of surgery include radial nerve palsy and heterotopic bone formation (10).…”

Réinsertion transosseuse par voie antérieure des ruptures du tendon distal du biceps brachial (biceps brachii [bb]) : évaluation des résultats

“…La rupture du tendon distal du BB est une pathologie relativement peu fréquente [2,3]. Cela explique le faible nombre des cas rapportés dans les publications en dehors de séries multicentriques : 11 cas pour Dojcinovic et al [2], neuf cas pour Chillemi et al [11], 16 cas pour Sigmundsson et al [12], 19 cas pour Behounek et al [13] et 22 cas pour Hetsroni et al [14].…”

“…Il est actuellement bien établi que le diagnostic d'une rupture du tendon distal du BB est surtout clinique [3,5].…”