Biceps Special Tests: Understanding Yergason's, Speed's, and Ludington's for Diagnosis

What is the special test for biceps?

While there isn't a single "special test" for the biceps, a battery of specific orthopedic special tests is employed by healthcare professionals to assess the integrity and pathology of the biceps muscle, particularly its long head tendon and associated structures like the transverse humeral ligament or superior labrum.

Understanding Biceps Anatomy and Pathology

The biceps brachii muscle is a two-headed muscle (long head and short head) originating from the scapula and inserting onto the radius. Its primary actions are elbow flexion and forearm supination, but the long head, in particular, plays a significant role in shoulder stability as it traverses the bicipital groove of the humerus and attaches to the superior glenoid labrum. Due to its anatomical course and function, the long head of the biceps tendon is susceptible to various pathologies, including:

• Tendonitis: Inflammation of the tendon, often due to overuse or impingement.
• Tenosynovitis: Inflammation of the tendon sheath.
• Instability/Subluxation: The tendon slipping out of the bicipital groove.
• Rupture: A complete tear of the tendon, most commonly affecting the long head.
• SLAP Lesions: Tears of the superior labrum that often involve the anchor point of the long head of the biceps tendon.

Special tests are clinical examination techniques designed to stress specific anatomical structures to elicit pain, instability, or other signs indicative of a particular injury or condition. For the biceps, these tests aim to isolate and challenge the long head tendon and its surrounding structures.

Key Special Tests for Biceps Pathology

Several tests are commonly used to evaluate the biceps tendon and its associated structures. Each test aims to provoke symptoms by placing specific stress on the tendon.

Yergason's Test

• Purpose: Primarily assesses the integrity of the transverse humeral ligament (which holds the long head of the biceps in the bicipital groove) and can indicate biceps long head tendonitis.
• Procedure: The patient sits with their elbow flexed to 90 degrees and the forearm pronated. The examiner stabilizes the elbow and resists the patient's active attempts to supinate the forearm and externally rotate the shoulder.
• Positive Result: Pain or an audible/palpable click or snap in the bicipital groove.
• Clinical Significance: Pain suggests biceps tendonitis. A click or snap indicates instability or subluxation of the biceps tendon from the bicipital groove, often due to a torn or lax transverse humeral ligament.

Speed's Test (Biceps Load II Test)

• Purpose: Evaluates for biceps long head tendonitis or superior labral (SLAP) lesions involving the biceps anchor.
• Procedure: The patient sits or stands with the arm extended straight out in front (shoulder flexed to approximately 60 degrees), elbow extended, and forearm supinated (palm up). The examiner applies downward resistance to the patient's arm while the patient attempts to maintain the position.
• Positive Result: Pain in the bicipital groove.
• Clinical Significance: Pain localized to the bicipital groove suggests biceps tendonitis. If the pain is also present or exacerbated when the arm is internally rotated (palm down), it may indicate a SLAP lesion, though its specificity for SLAP lesions is limited.

Ludington's Test

• Purpose: Specifically assesses for a complete rupture of the long head of the biceps tendon.
• Procedure: The patient sits or stands and places both hands on top of their head, interlinking their fingers. The patient then contracts their biceps muscles isometrically.
• Positive Result: Absence of tension in the biceps tendon on the affected side, or a visible "Popeye" deformity (a prominent bulge of the distal biceps muscle belly).
• Clinical Significance: A positive Ludington's test is a strong indicator of a complete rupture of the long head of the biceps tendon. The "Popeye" deformity occurs because the torn tendon retracts distally, causing the muscle belly to bunch up.

Interpreting Results and Clinical Considerations

It is crucial to understand that special tests are just one component of a comprehensive physical examination. No single test is 100% accurate, and results must be interpreted in conjunction with:

• Patient History: Details about the onset of pain, mechanism of injury, and aggravating/alleviating factors.
• Palpation: Feeling for tenderness, swelling, or deformities along the biceps tendon.
• Range of Motion Assessment: Evaluating active and passive movements of the shoulder and elbow.
• Strength Testing: Assessing the strength of elbow flexion and forearm supination.
• Differential Diagnosis: Considering other conditions that may present with similar symptoms (e.g., rotator cuff pathology, shoulder impingement, cervical radiculopathy).
• Imaging Studies: Such as MRI or ultrasound, which can provide definitive confirmation of tendon pathology.

A positive result on a special test suggests the involvement of a particular structure but does not definitively diagnose the condition. Similarly, a negative result does not always rule out pathology. Healthcare professionals use a cluster of tests and their clinical judgment to arrive at an accurate diagnosis.

When to Seek Professional Medical Advice

If you experience persistent pain, weakness, swelling, or a noticeable deformity in your shoulder or arm, especially after an injury or repetitive activity, it is essential to consult a qualified healthcare professional. This could include a physician, physical therapist, or sports medicine specialist. Early and accurate diagnosis is critical for appropriate management and to prevent further complications or chronic issues. Self-diagnosis and treatment based solely on special tests are not recommended.