CASE

Bye Bye Biceps: Case Report Describing Presentation, Physical Examination, Diagnostic Workup, and Treatment of Acute Distal Biceps Brachii Tendon Rupture.

Rupture of the distal biceps tendon is seen in both the emergency and primary care settings. It most commonly occurs after excessive tension exerted on a flexed forearm. Knowledge of the anatomy, pathophysiology, historical and physical examination findings, as well as the workup, diagnosis, and treatment of distal biceps tendon rupture are essential in achieving good outcomes, as delays in treatment can make surgical repair more challenging and less efficacious. A healthy 38-year-old male presented to his primary care physician complaining of right elbow pain that started while lifting an all-terrain vehicle into a truck. On physical examination, the patient had obvious deformity of the distal upper arm, as well as a positive squeeze test. Magnetic resonance imaging confirmed the presence of complete rupture of the distal biceps brachii tendon and the patient was referred to orthopedic surgery for evaluation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Prompt diagnosis and referral to orthopedic surgery optimizes outcomes and minimizes complications after distal biceps brachii tendon rupture. Oftentimes, gross examination shows obvious deformity of the distal upper arm, but when swelling, mobility limitations, or patient anatomy hinder this physical examination finding, the diagnosis can be missed. Knowledgeable emergency physicians can perform a physical examination and other diagnostic tests that can confirm or rule out a diagnosis in order to achieve the best outcomes for patients.

as reported in: Pflederer N, Zitterkopf Z, Saxena S. J Emerg Med. 2018 Nov:55(5):702-706. doi: S0736-4679(18)30837-0.