The patient is seated with the forearm resting comfortably in the patient,s lap with the elbow flexed to approximately 60–80 degrees and the forearm in slight pronation.
Standing on the involved side, the clinician squeezes the biceps firmly with one hand stablizing the upper extremity and the other hand around the belly of the biceps brachii muscle.
What does a positive Ruland Biceps Squeeze Test mean?
A biceps squeeze test is positive if there is a loss of forearm supination as the biceps brachii muscle is squeezed. This indicates a distal biceps tendon rupture.
Sensitivity & Specificity
A study by Ruland1 to evaluate biceps squeeze test for diagnosis of distal biceps tendon ruptures, he found that this test has a high Sensitivity & Specificity in diagnostic distal biceps tendon injury:
Sensitivity: 96 %
Specificity: 100 %
The Biceps brachii muscle consists of two heads, the short head and long head.
The Short head originates from the coracoid process of the shoulder, while the long head originates from Supraglenoid rim of the shoulder joint.
This two heads unite to form the muscle belly, it’s tendon (the distal biceps tendon) inserts onto the radial tuberosity of the radius.
It’s function include flexion of the elbow joint and supination of the forearm.
The Biceps brachii muscle is innervated by the Musculocutaneous nerve.
Biceps Tendon Rupture
The biceps tendon can be avulsed partially or completely either at the musculotendinous junction or at the radial tuberosity.
Avulsions of the biceps tendon at the elbow occur almost exclusively in males,176 and the most common scenario is a rupture of the dominant elbow of a muscular male in his fifth decade of life.
Biceps ruptures typically involve a sudden contracture of the biceps against a significant load with the elbow in 90 degrees of flexion.
Biceps Tendon Rupture Symptoms:
The typical history includes a report of a sharp, tearing pain concurrent with an acute injury in the antecubital fossa.
Clinical findings vary depending on the extent of the rupture; whether it is partial or complete.
The objective findings may include:
Ecchymosis in the antecubital fossa,
A palpable defect of the distal biceps,
Loss of strength of elbow flexion and grip, but especially a loss of forearm supination strength.
In active individuals, the normal recommendation is primary repair of the acute tendon avulsion. If not repaired, a 30% loss of elbow flexion and a 40% loss of supination strength can be expected2.
Postoperatively, the elbow is protected for 6–8 weeks, after which unrestricted range of motion and gentle strengthening exercises are initiated. Return to unrestricted activity is usually not allowed until nearly 6 months of healing has passed.
RT Ruland, Robert P Dunbar, JD Bowen: The biceps squeeze test for diagnosis of distal biceps tendon ruptures. August 2005, Clinical Orthopaedics and Related Research. Link
Morrey BF, Askew LJ, An KN, et al: Rupture of the distal tendon of the biceps brachii: a biomechanical study. J Bone Joint Surg 67A:418–421, 1985.
Hempel K, Schwencke K: About avulsions of the distal insertion of the biceps brachii tendon. Arch Orthop Unfallchir 79:313–319, 1974.
McReynolds IS: Avulsion of the insertion of the biceps brachii tendon and its surgical treatment. J Bone Joint Surg 45A:1780–1781, 1963.
Mark Dutton, Pt . Dutton’s Orthopaedic Examination, Evaluation, And Intervention, 3rd Edition Book.