Distal biceps tendon tear, Hook Test - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim's animated educational video describing the Hook Test. Distal Biceps Tendon Rupture
The hook test is a test used to diagnose distal biceps tendon rupture, avulsion or tear. The biceps tendon inserts into the proximal radius at the radial tuberosity at the elbow.
Rupture of the distal biceps tendon
When the biceps tendon ruptures, it will cause pain at the elbow.
The patient will experience a sharp, sudden, painful “pop” at the elbow from unexpected extension force when the elbow is at 90 degrees of flexion. The condition occurs in middle aged men, usually involving the dominant extremity. It is a single traumatic event with eccentric force on the flexed elbow. There might be ecchymosis at the elbow and weakness of supination and flexion of the elbow.
There may be a palpable defect with proximal retraction of the biceps muscle belly. If rupture of the tendon is not diagnosed and repaired, then there will be loss of 40-50% of supination and 30% of flexion of the elbow.
Hook test
Performed to diagnose rupture or tear of the distal biceps tendon. The examiner will use the index finger to hook the biceps tendon from the lateral side of the elbow.
How do u do the hook test?
•The patient flexes the elbow to 90 degrees and fully supinates the forearm
•Use the index finger to hook the lateral edge of the biceps tendon.
•If the tendon is intact or partially torn, the finger will be inserted below the tendon and hook it.
•If the tendon cannot be hooked, then this means that there is a complete tear of the distal biceps tendon.
There may be false positives involved with the hook test, such as partial tears of the distal biceps, an intact lacertus fibrosis, or mistakenly hooking the brachialis tendon.
Squeeze test
•The squeeze test is another test that may be used to diagnose distal biceps tendon rupture.
•Thompson’s test
•The squeeze test is similar to the Thompson's test which is used to diagnose Achilles tendon rupture.
•Flex the elbow to 80 degrees and keep the forearm in some pronation.
•Then squeeze the biceps with one hand or with two hands. Supination of the forearm will occur if the biceps is intact.
•no supination of the forearm will occur if he biceps is torn.
The problem with diagnosing distal biceps tendon tears is differentiating between partial and complete tears because both have the same clinical pictures.you could see a palpable defect with a complete distal biceps tear which could help the diagnosis.
Partial biceps tendon tears are rare and frequently misdiagnosed and underdiagnosed. The patient will have pain in the elbow and the patient will also have a normal hook test.
MRI may be helpful in diagnosing partial tear of the distal biceps tendon. MRI may not be needed in all cases. MRI will diagnose a tear, the degree of retraction and if the tear is complete or partial.

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