66-year-old patient presenting with acute anterior shoulder pain and possible deformity of the upper arm. Symptoms may include sudden onset pain, weakness, and possible “Popeye” sign. Further clinical details not provided.
Ultrasound examination demonstrates a complete rupture of the long head of the biceps tendon at the level of the musculotendinous junction.
There is absence of the normal fibrillar tendon structure at the expected location, with discontinuity of the tendon fibers. The proximal tendon is not visualized in continuity, consistent with full-thickness rupture.
At the musculotendinous junction, there is likely retraction of the muscle-tendon unit, which may be associated with a hypoechoic area representing edema or hematoma.
No intact tendon fibers are seen bridging the defect.
1. Final diagnosis
Complete rupture of the long head of the biceps tendon at the musculotendinous junction.
2. Differential diagnosis
Consider proximal tendon rupture at the bicipital groove (more common location), or severe tendinopathy with near-complete tear. Correlation with clinical findings (e.g., Popeye deformity) is helpful.
3. Teaching points
The long head of the biceps most commonly ruptures proximally at the bicipital groove, but musculotendinous junction ruptures can occur. Ultrasound shows absence of the tendon and discontinuity of fibers. Identification of the rupture level is important for accurate diagnosis.
4. Injury/disease information
Rupture of the long head of the biceps tendon is often associated with chronic degeneration or acute overload. While proximal ruptures are more common and often managed conservatively, the exact location of the rupture may influence clinical presentation and management decisions.
Marc is founder of, and trainer at, SonoSkills. SonoSkills is an organization dedicated to MSK ultrasound education. He's also an MSK Sonographer at the Laurentius Hospital in Roermond, the Netherlands.
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