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The characteristic finding of a biceps tendon rupture is the Popeye sign. Patients often report an audible pop at the time of injury as well as pain, bruising, and swelling. Provocative physical exam maneuvers to assess for a rupture include Ludington's test, Hook test, and the Ruland biceps squeeze test.
It identifies the presence of a pathology involving the biceps tendon or glenoid labrum. The specific positive findings to the test include pain in the bicipital groove indicating biceps tendinitis, [2] [3] subluxation of the long head of the biceps brachii muscle, [3] and presence of a SLAP tear. [4]
Biceps tenotomy and tenodesis are often performed concomitantly with rotator cuff repair or as separate procedures, and can also cause shoulder pain. Tenodesis, which may be performed as an arthroscopic or open procedure, generally restores pain free motion it the biceps tendon, or attached portion of the labrum, but can cause pain.
The tests differ in the rotation of the arm; in the empty can test, the arm is rotated to full internal rotation (thumb down) and in the full can test, the arm is rotated to 45° external rotation, thumb up. [1] Once rotated, the clinician pushes down on either the wrists or the elbow, and the patient is instructed to resist the downward pressure.
The long head of the biceps passes through the shoulder joint and attaches to the labrum. During a biceps tenodesis procedure, the surgeon cuts the attachment of the biceps tendon from the labrum and reattaches it to the humerus bone by tacks. By doing this, pressure is relieved from the labrum significantly reducing pain.
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Hawkins–Kennedy test: a positive test indicates shoulder impingement syndrome; Empty beer can test: a positive test indicates rotator cuff tear, specifically, supraspinatus muscle tear; Drop arm test: a positive test indicates a supraspinatus tear; External Rotation test: a positive test indicates an infraspinatus or teres minor tear