The biceps squeeze test for diagnosis of distal biceps tendon ruptures

Using the Thompson test for Achilles tendon rupture as a model, we developed the biceps squeeze test to test the integrity of the distal biceps tendon. We wanted to determine if failure to elicit supination with the biceps squeeze test would indicate complete distal biceps rupture. We also wanted to determine if surgical reattachment of the tendon would reestablish the supination response of the biceps squeeze test, and if patients who did not have surgery would have the same response to the biceps squeeze test months after injury. Twenty-five consecutive patients with 26 presumptive distal biceps tendon ruptures were evaluated with the biceps squeeze test. The biceps squeeze test was positive in 24 patients. Twenty-two patients had surgical repair. Twenty-one of 22 patients had operative confirmation of a complete distal biceps tendon rupture. All patients who had surgery had return of supination with the biceps squeeze test immediately after reattachment and at 3 months followup. Two patients with a positive biceps squeeze test declined surgery and did not have a return of supination with the biceps squeeze test at 3 months followup. Sixty-five patients with no history of upper extremity trauma were evaluated with the biceps squeeze test as a control group. All 65 patients had supination of the forearm in response to the test. The biceps squeeze test is simple, reliable, cost-effective, and aids in the diagnosis of distal biceps tendon ruptures.

Diagnostic study, Level II-1 (development of diagnostic criteria on basis of consecutive patients-with universally applied reference "gold" standard). See the Guidelines for Authors for a complete description of levels of evidence.