Biceps Tendon Tests

What are the Biceps Tendon Test?

Biceps Tendon is a common cause of shoulder pain with its proximal arising, and elbow pain with its distal insertion. Many tests have been described to diagnosis its pathology.

Biceps Tendon Tests include the following:

1. Yergason Test.
2. Speed Test.
3. Nonspecific Biceps Tendon Test.
4. Abbott-Saunders Test.
5. Snap Test.
6. Hueter Sign.
7. Ludington Test.
8. Lippman Test.

See Also: 
- Yergason Test
- Speed Test

Biceps Tendon Tests

Nonspecific Biceps Tendon Test:

The patient holds the arm abducted in neutral rotation with the elbow flexed 90°. The examiner immobilizes the patient’s elbow with one hand and places the heel of the other hand on the patient’s distal forearm . The patient is then asked to externally rotate his or her arm against the resistance of the examiner’s hand.

Pain in the bicipital groove or at the insertion of the biceps suggests a tendon disorder. Pain in the anterolateral aspect of the shoulder is often a sign of a disorder of the rotator cuff , especially the infraspinatus tendon.

Abbott-Saunders Test:

Abbott-Saunders Test Demonstrates subluxation of the long head of the biceps tendon in the bicipital groove.

The patient’s arm is externally rotated and abducted about 120° with progressive internal rotation. The examiner slowly lowers the arm from this position. The examiner guides this motion of the patient’s arm with one hand while resting the other on the patient’s shoulder and palpating the bicipital groove with the index and middle fingers.

Pain in the region of the bicipital groove or a palpable or audible snap suggest a disorder of the biceps tendon (subluxation sign). An inflamed bursa (subcoracoid or subscapular bursa) can also occasionally cause snapping.

Snap Test:

Snap test tests for subluxation of the long head of the biceps tendon.

The examiner palpates the bicipital groove with the index and middle finger of one hand. With the other hand, the examiner grasps the wrist of the patient’s arm (abducted 80 to 90° and flexed 90° at the elbow ) and passively rotates it at the shoulder, first in one direction and then in the other.

Subluxation of the long head of the biceps tendon out of the bicipital groove will be detectable as a palpable snap.

Hueter Sign:

The patient is seated with the arm extended at the elbow and the forearm in supination. The examiner grasps the posterior aspect of the patient’s forearm . The patient is then asked to flex the elbow against the resistance of the examiner’s hand.

In a rupture of the long head of the biceps tendon, the distally displaced muscle belly can be observed as a “ball” directly proximal to the elbow w hen the upper arm muscles contract.

Ludington Test

The patient sits or stands and is asked to place both hands behind the head, interlocking the fingers. In this position both arms are relaxed. The patient is then asked to alternately relax and contract the biceps muscle, while the examiner palpates the long head of the biceps tendon at the same time.

In comparing the two sides, if the examiner notes tenderness or subluxation of the tendon, this suggests an unstable tendon, tendinitis, or even a defect of the transverse ligament.

Lippman Test

The patient sits or stands and the examiner holds the arm and flexes it to 90°. The examiner now palpates the biceps tendon at the level of the bicipital groove, about 9 cm distal to the glenohumeral joint, and attempts to move it back and forth.

The test is positive if the patient feels pain along the course of the biceps tendon during this examination.

Gilchrest’s Sign

In standing position, the patient is instructed to lift a 2- to 3-kg weight over the head. The arm is then externally rotated fully and lowered to the side.

A positive test is indicated by discomfort or pain in the bicipital groove which would indicate paratendinitis/tendinosis.

References

• Ludington NA. Rupture of the long head of the biceps flexor cubiti muscle. Ann Surg. 1923;77:358–63.
• Micheroli R, Kyburz D, Ciurea A, Dubs B, Toniolo M, Bisig SP, Tamborrini G. Correlation of findings in clinical and high resolution ultrasonography examinations of the painful shoulder. J Ultrason. 2015 Mar;15(60):29-44. doi: 10.15557/JoU.2015.0003. Epub 2015 Mar 30. PMID: 26674725; PMCID: PMC4579705.
• Davies GJ, Gould JA, Larson RL. Functional examination of the shoulder girdle. Phys Sportsmed. 1981;9:82–104.
• Post M. Physical examination of the musculoskeletal system. Chicago: Year Book Medical; 1987.
• Lippman RK. Frozen shoulder: periarthritis, bicipital tendinitis. Arch Surg. 1943;7:283–96.
• Clinical Tests for the Musculoskeletal System 3rd Edition.
• Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.