MyPACS.net: Radiology Teaching Files > Case 13229384

previously visited RUPTURED BICEPS
Contributed by: Andrew Graham, Horizon Scanning, New Zealand.
Patient: 44 year old male
History: 44 year old male injured his right shoulder while 'arm wrestling' Felt a 'pop' in his shoulder.
Images:[small]larger

Fig. 1: The bicipital groove with no long head of biceps tendon within it.

Fig. 2: Longitudinal view of the upper humerus showing no long head of biceps tendon.

Fig. 3: Just below the musculotendinous junction with obvious haemorrhaging due to complete rupture

Fig. 4: Transverse view of the musculotendinous junction showing 'Bull nosing' of the biceps tendon/muscle

Fig. 5: Bruising noted over the musculotendinous junction of the biceps

Fig. 6: "Popeye" sign.

Fig. 7: Normal biceps on left with our patient on right. The biceps tendon of our patient

Fig. 8: Normal biceps on left with our patient on right. The biceps tendon of our patient
Findings:

The long head biceps tendon is not seen within the bicipital groove and there is 'bull nosing' of the muscle belly. In addition there is a soft tissue collection around the distal tendon typical for haemorrhage. These findings are consistent with a complete rupture of the long head biceps tendon.

 

The subscapularis, supraspinatus, and infraspinatus tendons of this shoulder are intact and normal in appearance.

 

No bursal fluid and no impingement is detected.

Diagnosis: Ruptured longhead of biceps
Discussion: Biceps Brachii is composed of 2 heads.  The long head of biceps tendon connects the muscle to the superior shoulder socket, the glenoid. Arisinh from the glenoid,above the fossa,  the tendon of the long head of the biceps travels anteriorly within the bicipital groove and is held in place by the transverse humeral ligament.

The short head of the biceps arises from the corocoid process of the scapula.

Ruptures of the biceps tendon predominantly occur in the longhead tendon. It occurs most often in middle-aged people and is usually due to years of wear and tear on the shoulder. A torn biceps in younger athletes sometimes occurs during weightlifting or from actions that cause a sudden load on the arm, such as hard fall with the arm outstretched.

Patients often recall hearing and feeling a snap in the top of the shoulder. Immediate and sharp pain follows, but the pain often subsides quickly with a complete rupture because tension is immediately taken off the pain sensors in the tendon. 

Bruising may develop in the middle of the upper arm and spread down to the elbow. The biceps may appear to have balled up (Popeye sign), especially in younger patients who have had a traumatic biceps rupture. The arm may feel weak when attempting to bend the elbow or lift the shoulder

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 examination of the biceps tendons.
References: Branch, G (2007). Biceps Rupture. retrieved from:http://www.emedicine.com/pmr/topic15.htm. 12 February, 2008.

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Additional Details:

Case Number: 13229384Last Updated: 02-14-2008
Anatomy: Skeletal System   Pathology: Trauma
Modality: USAccess Level: Readable by all users
Keywords: biceps

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