Orthopedic Associates of Hartford, Farmington, CT, USA.
Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA.
J Shoulder Elbow Surg. 2022 Aug;31(8):1603-1609. doi: 10.1016/j.jse.2022.02.012. Epub 2022 Mar 22.
Partial tears of the distal biceps tendon can be difficult to diagnose based on clinical examination and magnetic resonance imaging (MRI).
Patients from a single surgeon's practice from 2000 to 2018 with a partial distal biceps tendon tear were retrospectively reviewed to determine the utility of the distal biceps palpation-rotation test in the detection of partial tears. This test is performed by palpating the bicipital tuberosity at the lateral forearm while ranging the forearm from supination to pronation with the arm adducted at the patient's side and the elbow flexed to 90°. A positive test elicits tenderness at the tuberosity with the arm in pronation but not in supination. Examination findings were correlated with MRI reports confirming a partial tear. Twelve cadaveric arms were dissected to determine overall pronosupination range of motion, the degree of pronation at which the bicipital tuberosity is maximally palpable, and anatomic measurements of the bicipital tuberosity to guide the optimal technique when carrying out the maneuver.
Ninety-nine patients were diagnosed with a partial distal biceps tendon, of whom 34 had available MRI reports and complete physical examination documentation. Thirty-three of 34 patients (97%) had partial tears on MRI. The hook test was negative in all cases. All patients had tenderness with resisted supination. In those with MRI-confirmed partial tears, the palpation-rotation test was positive in all patients (100% sensitivity). The bicipital tuberosity was maximally palpated at the dorsolateral forearm at a mean 20° of pronation, and the proximal and distal boundaries of the radial tuberosity were 2.5 cm and 5.3 cm, on average, distal to the radial head, respectively.
A positive palpation-rotation test was seen in 33 of 33 patients (100% sensitivity), as correlated with MRI. The combination of an intact distal biceps tendon within the antecubital fossa, tenderness on resisted supination, and a positive palpation-rotation test are highly suggestive of a partial distal biceps tendon tear.
基于临床检查和磁共振成像（MRI），很难诊断远端二头肌肌腱的部分撕裂。
对 2000 年至 2018 年期间一位外科医生的患者进行回顾性研究，这些患者存在部分远端二头肌肌腱撕裂，以确定远端二头肌触诊-旋转试验在检测部分撕裂中的作用。该试验是通过在患者的侧前臂触诊二头肌结节，同时使前臂从旋后位到旋前位，手臂在患者身边内收，肘部弯曲至 90°来进行的。阳性试验在旋前位时引起结节处压痛，但在旋后位时则不会。检查结果与 MRI 报告相吻合，证实存在部分撕裂。对 12 具尸体手臂进行解剖，以确定总体旋前-旋后范围、最大触诊二头肌结节的旋前程度以及二头肌结节的解剖测量，以指导进行该操作的最佳技术。
99 例患者被诊断为远端二头肌部分撕裂，其中 34 例有可用的 MRI 报告和完整的体格检查记录。34 例患者中有 33 例（97%）MRI 证实有部分撕裂。钩试验在所有病例中均为阴性。所有患者在抵抗旋后时均有压痛。在 MRI 证实存在部分撕裂的患者中，触诊-旋转试验在所有患者中均为阳性（敏感性 100%）。二头肌结节在旋前 20°时最大程度地位于前臂的背外侧，桡骨结节的近端和远端边界分别平均距离桡骨头 2.5 厘米和 5.3 厘米。
与 MRI 相关，触诊-旋转试验在 33 例患者中的 33 例（敏感性 100%）中为阳性。完整的二头肌肌腱在肘前窝内、抵抗旋后时的压痛和触诊-旋转试验阳性高度提示存在远端二头肌部分撕裂。
