Supination Pronation Test | Distal Biceps Tendon Rupture Assessment

The Supination Pronation Test is an orthopedic test used in the assessment of distal biceps tendon ruptures. If you follow us closely you know we have covered two other tests for distal biceps tendon ruptures: The hook test and the biceps squeeze test. Metzman et al. (2015) argue that these tests may not be suitable in an acute situation due to their provocative nature, which is why they propose the supination-pronation test. While they reliably diagnosed complete ruptures in 5 patients as confirmed with MRI and surgical exploration, the test has not been subject to diagnostic accuracy studies which is why its clinical value remains questionable.

To conduct the test, the patient is asked to abduct the arms to 90°. If that is not possible, they may support them on the treatment bench.
Then, the patient should flex the arm to around 70° and is instructed to pro and supinate the forearm.
The examiner will observe the contours of the biceps, which should move proximally during supination and distally during pronation as seen in Kai here. It’s advised to compare the visual with the unaffected side and if the contours of the muscle are hard to identify, the muscle belly may be palpated for movement.

The test is considered positive for a distal biceps tendon rupture if migration of the biceps during pro and supination is absent.

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

• Ludington’s Test
• Hook Test
• Biceps Crease Interval
• Tilt Sign
• Biceps Squeeze Test

Metzman, L. S., & Tivener, K. A. (2015). The Supination-Pronation Test for Distal Biceps Tendon Rupture. American Journal of Orthopedics (Belle Mead, NJ), 44(10), E361-4.