gms | German Medical Science

Background: Partial biceps tendon ruptures are often missed; therefore a reliable clinical test is needed.

Hypothesis: Partial distal biceps tendon ruptures and bursitis can be reliably diagnosed with the pronation-flexion provocation test.

Methods: The pronation-flexion provocation test was performed by a single surgeon in a cohort of 30 patients with a confirmed partial distal biceps tendon rupture and a cohort of 30 patients with other elbow pathology. To perform the flexion pronation provocation test the patient is asked to actively flex the elbow from a pronated position of the forearm with the elbow tucked in to the patient's side and with the elbow in ninety degrees of flexion. The examiner's hands are placed on the patient's forearm and the patient's flexion is resisted. Care is taken not to place the hands on the hand or wrist as resisted wrist flexion might elicit pain in other elbow pathologies. The test is positive when the patient indicates pain when active flexion is resisted.

Results: The flexion-pronation provocation test was positive in all patients with distal biceps tendon pathology. The VAS score averaged at seven out of ten (range 4-9). The VAS score for the supination-flexion resistance test averaged at one out of ten (range 0-5). In the control group the VAS score for the flexion-pronation provocation test averaged at zero out of ten (range 0-1) while the VAS score for the supination-flexion resistance test averaged at 1 (range 0-2).

Conclusions: The pronation-flexion provocation test is highly reliable and accurate in the clinical diagnosis of partial biceps tendon ruptures.