Biceps Crease Interval | Distal Biceps Tendon Rupture Assessment

The goal of the Biceps Crease Interval is to identify patients with distal biceps tendon retraction significant enough to compromise surgical results if they are not quickly referred for surgery.

ElMaraghy et al. (2008) originally described the test in their study and report updated statistical values in their study from 2013 that included a bigger patient sample.

They report a sensitivity of 88% and a specificity of 50% with an interrater reliability ICC of 0.794 which gives it a weak clinical value as a standalone test.

To conduct the test, first, flex the patient’s arm and look for the main antecubital flexion crease, then extend the elbow and supinate the forearm.
Next, mark the flexion crease in the antecubital fossa with a pen.
In the following step, stroke the distal biceps back and forth along a central line parallel to its long axis that might not be perpendicular to the crease.
Try now to identify the cusp of the biceps, which is the point at which the distal biceps begins to turn most sharply towards the antecubital fossa. Once you found that point, mark it with another transverse line.
Then measure the distance between the two lines in centimeters to one decimal point along the previously described central line.
Repeat the steps on the other arm.

The test is positive if the biceps crease interval is longer than 6cm or if the ratio between the affected and unaffected arm is greater than 1.2 indicating retraction of the muscle that requires surgical attention.

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

• • Name*
• • Email*

Δ

Other common orthopedic tests to assess for distal biceps tendon ruptures are:

• Ludington’s Test
• Hook Test
• Supination Pronation Test
• Tilt Sign
• Biceps Squeeze Test

Devereaux, M. W., & ElMaraghy, A. W. (2013). Improving the rapid and reliable diagnosis of complete distal biceps tendon rupture: a nuanced approach to the clinical examination. The American Journal of Sports Medicine, 41(9), 1998-2004.

ElMaraghy, A., Devereaux, M., & Tsoi, K. (2008). The biceps crease interval for diagnosing complete distal biceps tendon ruptures. Clinical orthopaedics and related research, 466(9), 2255-2262.