Tilt Sign | Distal Biceps Tendon Rupture Assessment | Biceps Tear

On our website you will find several tests used in the diagnosis of complete distal biceps tendon ruptures. Partial tears of the distal tendon are more subtle in their presentation which is why Shim et al. (2017) proposed the tilt sign.

In their case reports, they have found it to be 100% specific in detecting a partial tear of the distal biceps tendon when compared with MRI imaging. But as it’s a novel test that has not been investigated in diagnostic accuracy studies, the clinical value er remains questionable for now.

To conduct the test the patient is in standing or sitting position and is asked to flex the elbow to 90°. Then, locate the head of the radius and you can do this by alternating supination and pronation. Then, fully pronate the forearm and move approximately 2.5cm or 1 inch distally to the region of the radial tuberosity which is the attachment site of the biceps. It’s essential to fully pronate the forearm, as this will rotate the radius so that the radial tuberosity lies directly under your palpating finger. Then, palpate the radial tuberosity.

A positive test will result in tenderness upon palpation over the radial tuberosity because if there is a partial tear of the biceps tendon there will typically be inflammation which will evoke pain.

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

• Ludington’s Test
• Hook Test
• Supination Pronation Test
• Biceps Squeeze Test
• Biceps Crease Interval

Shim, S. S., & Strauch, R. J. (2018). A novel clinical test for partial tears of the distal biceps brachii tendon: the TILT sign. Clinical Anatomy, 31(2), 301-303.