x
x

Hook Test

Exams and Signs

Historical Overview

  • In 2007, O’Driscoll described the hook test and documented over a decade of clinical testing.1

Description

  • The hook test is vital for a diagnosis of biceps tendon ruptures, which are easily missed in physical examinations of the distal biceps.1,2

Pathophysiology

Biceps rupture is most often caused by an injury or a falling accident. It can also result from overuse of the biceps, particularly in carpenters or construction workers.3 In female patients, complete biceps ruptures can occur; however, partial ruptures are more common.4

Instructions

  1. Obtain an accurate and complete patient history.
  2. Ask the patient to flex the elbow to 90° and to supinate the forearm.1
  3. To check the patient’s right elbow, bring your left index finger from the lateral side of the antecubital fossa beneath the lateral edge of the patient’s biceps tendon in order to hook the tendon.1 To check the patient’s left elbow, follow this step in mirror image.
  4. If the hook test is normal, i.e. negative, pull on the biceps tendon, to determine if this elicits tenderness in the antecubital fossa. Tenderness would suggest a possible partial biceps tendon repair.
  5. If the patient has a complete biceps tendon tear, the hook test will be positive. If the patient has a partial tear, the hook test will likely be negative but probably painful.1

Variations

  • (NA)

Related Signs and Tests

  • Muscle test: biceps
  • Range of motion: active
  • Range of motion: passive
  • Magnetic resonance imaging (MRI)

Diagnostic Performance Characteristics

  • The hook test is both sensitive and specific. It has a higher sensitivity and specificity than MRI, for complete distal tears.2

Differential Diagnoses

  • Tendinitis
  • Falling injury4

Additional Information

Presentation Photos and Related Diagrams
Hook Test
  • The hook Test was originally described by Driscoll. The patient holds the elbow in 90 degrees of flexion and full supination. The examiner’s index finger is inserted from lateral to medial at the antecubital fossa’s flexion crease. If the biceps is intact the examining finger can go behind the palpable biceps tendon and pull against it. If the tendon was ruptured, the examining finger would just push against the skin and subcutaneous tissues.
    The hook Test was originally described by Driscoll. The patient holds the elbow in 90 degrees of flexion and full supination. The examiner’s index finger is inserted from lateral to medial at the antecubital fossa’s flexion crease. If the biceps is intact the examining finger can go behind the palpable biceps tendon and pull against it. If the tendon was ruptured, the examining finger would just push against the skin and subcutaneous tissues.
Definition of Positive Result
  • A positive result occurs when the examiner’s finger cannot be placed beneath the patient’s biceps tendon approximately 1 cm and, for some patients, up to the distal interphalangeal joint of the examiner’s finger.1 In a positive test, the tendon can not be “hooked” because it is ruptured and retracted out of the antecubital fossa.
Definition of Negative Result
  • A negative result occurs when the examiner’s finger can be placed beneath the patient’s intact biceps tendon approximately 1 cm. With a negative test, the examiner can pull on the intact tendon and there is not tenderness and the tendon resists the examiner’s pull. 
Comments and Pearls
  • If the interval between biceps tendon rupture diagnosis and surgery increases, complications will be more likely following surgical treatment.1
  • The hook test may help to differentiate between intact, partial tears, and complete biceps tendon rupture.3
Diagnoses Associated with Exams and Signs
References
  1. O’Driscoll SW, Goncalves LBJ, Dietz P. The hook test for distal biceps tendon avulsion. Am J Sports Med 2007;35(11):1865-9. PMID: 17687121
  2. Srinivasan RC, Pederson WC, Morrey BF. Distal biceps tendon repair and reconstruction. J Hand Surg Am 2020;45(1):48-56. PMID: 31901332
  3. Hobbs MC, Koch J, Bamberger HB. Distal biceps tendinosis: evidence-based review. J Hand Surg Am 2009;34(6):1124-6. PMID: 19442457
  4. Bauman JT, Sotereanos DG, Weiser RW. Complete rupture of the distal biceps tendon in a woman: case report. J Hand Surg 2006; 31A:798-800. PMID: 16713845
Subscribe to Hook Test
⇡