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Supraspinatus rupture
4%
2/54
Infraspinatus rupture
Biceps tendinopathy
2%
1/54
Biceps tendon rupture
81%
44/54
Biceps muscle tear
6%
3/54
Select Answer to see Preferred Response
This patient is presenting with arm pain and a palpable "bunched up" biceps muscle after experiencing a popping sensation associated with exertion. These clinical findings are concerning for a biceps tendon rupture. A biceps tendon rupture tends to present in older individuals who over-exert themselves and then experience a classic "popping" in their arm/shoulder associated with pain. These patients will present with pain with lifting, carrying, or reaching, and will have decreased strength to forearm flexion and arm abduction. On physical exam you can typically see a bulge in the arm which represents the biceps muscle as it contracts down after losing its insertion point (Figure A). Figure A demonstrates a bulge ("Popeye" deformity) seen in the arm in a patient with a biceps tendon rupture. Incorrect Answers: Answer 1: Supraspinatus rupture will present with pain/weakness upon abduction of the arm, a positive empty-can test, and atrophy over the supraspinatus muscle. It is not associated with weakness of flexion of the forearm or a palpable mass in the arm. Answer 2: Infraspinatus rupture is a less common injury that will present with pain/weakness upon abduction of the arm and atrophy of the infraspinatus muscle. It is not associated with weakness of flexion of the forearm or a palpable mass in the arm. Answer 3: Biceps tendinopathy will present with pain with flexion of the forearm/arm and pain with abduction of the arm. It will also present with tenderness over the biceps tendon; however, it will not present with a bunched up muscle over the arm - this is more likely associated with a tendon rupture. Answer 5: A tear of the biceps muscle would result in pain/weakness upon flexion of the forearm, erythema, and bruising overlying the bicep. It is less likely to occur than a biceps tendon rupture and would not likely present with a bunched up muscle overlying the arm (unless it was a complete tear). Bullet Summary: Biceps tendon rupture occurs in older individuals after exertion and presents with weakness/pain upon flexion of the forearm/arm, abduction of the arm, and a palpable mass overlying the arm.
4.4
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