Ludington’s Test | Proximal Long Head of the Biceps Tendon Rupture Assessment

Ludington’s Test is an orthopedic test used in the assessment of proximal biceps tendon ruptures.

If you’ve followed our channel for a while you may remember a series of videos on distal biceps tendon ruptures. However, it’s more prevalent that the proximal tendon of the long head of the biceps ruptures. One key feature is the popeyes sign that looks like this:

Ludington described a case study of a worker who felt a sharp pain in the anterior shoulder after lifting a crate. Suspecting a rupture of the proximal biceps tendon, he proposed a new test to assess the integrity of the long head of the biceps tendon. However, this method has never undergone diagnostic accuracy assessment, thus the clinical value remains questionable.

To conduct the test, the patient is in sitting or standing position. The patient is asked to place their hands on their head and to interlock the fingers so they support the weight of the arms. In this position, the biceps can relax as much as possible. Place two fingers over each long biceps tendon and ask the patient to contract and relax both biceps simultaneously.

In a positive test, the contraction is not felt on the affected side compared to the unaffected arm.

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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

• Supination Pronation Test
• Hook Test
• Biceps Crease Interval
• Tilt Sign
• Biceps Squeeze Test

References

Ludington, N. A. (1923). Rupture of the long head of the biceps flexor cubiti muscle. Annals of Surgery, 77(3), 358.

Gupta, S., Crocker, A., Scheirer, J., & Alweis, R. (2013). Images in clinical medicine: Popeye’s sign. Journal of Community Hospital Internal Medicine Perspectives, 3(2), 20688.