PR_137: Partial Tear of the Biceps Tendon at the Proximal Musculotendinous Junction: A Case Report

Abstract

Setting: University hospital, outpatient practice. Patient: A 44-year-old public safety officer. Case Description: The patient presented with a chief complaint of left anterior shoulder pain. He described a mechanism of injury that involved resisted left shoulder and arm abduction and extension. Physical examination was subsequently positive for painful active range of motion on left shoulder abduction and flexion, pain on palpation over left bicipital tendon, and ecchymosis in anterior shoulder and arm. Special tests, which included Speed’s, Popeye’s, and apprehension signs, were equivocal. Assessment/Results: Magnetic resonance imaging of the left shoulder was ordered on follow-up for confirmation of a suspected long head of the biceps tendon tear. However, imaging was negative for rotator cuff, bicipital tendon, or labral pathology. Imaging of patient’s left humerus was then obtained, which confirmed an intrasubstance partial tear of the biceps tendon near the proximal musculotendinous junction. The patient returned to full-duty work 2 weeks after initial injury. Discussion: In 96% of cases of biceps tendon injury, the rupture occurs in the long head. 3% of injuries occur in the distal biceps tendon, and 1% in the short head. As this case illustrates, it is often difficult when evaluating proximal biceps tendon lesions to determine the location of the rupture. Of note, this patient quickly returned to his functional baseline with a treatment regimen that involved rest, ice, and oral anti-inflammatory medication. Conclusions: This case illustrates the clinical and radiologic difficulties one encounters when treating atypical biceps muscle and tendon injuries. The treating physician must be aware of the possibility of short head of biceps tendon, coracobrachialis, or musculotendinous junction injuries. A nonoperative and conservative management approach to these injuries is the standard of care. Last, the potential expanded use of musculoskeletal ultrasound in the diagnostic workup for these injuries appears valuable.