Distal Biceps Provocation Test.

PURPOSE: To describe and study a test for distal biceps tendon pathology other than complete tears.

METHODS

In this prospective study, the biceps provocation test (BPT) was performed in a cohort of 30 patients with suspected distal biceps tendon pathology and 30 patients with another elbow pathology. Patients with a complete tear were excluded. Diagnosis was confirmed on magnetic resonance imaging or from surgical findings. The BPT is a 2-part test. The elbow is flexed to 70° with the forearm supinated. The examiner's hands are placed on the patient's forearm and the patient is asked to flex the elbow against resistance (BPTs). The forearm is then pronated and the test is repeated (BPTp). Pain is documented for both supination and pronation using a visual analog scale from 0 to 10. The test is positive when the patient indicates an increase in pain with BPTp compared with BPTs.

RESULTS

The BPT was positive in all patients with distal biceps tendon pathology. The average visual analog scale score in this group was 1 (range, 0-7) for the supinated part of the test (BPTs) and 7 (range, 4-10) with the forearm in pronation (BPTp), with an average increase of 5 points (range, 2-8). This difference was significant. No significant difference was found in the control group. Among the controls, BPTp and BPTs were rated as equally painful by 27 patients, and BPTp was less painful than BPTs in 3. Sensitivity and specificity were both 100% in this small group of 60 patients, with a high prevalence of distal biceps tendon pathology.

CONCLUSIONS

The BPT appears to be highly sensitive and specific for distal biceps partial injury or tendinitis.

TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic II.