Hook test

The hook test for distal biceps tendon avulsion.

O'Driscoll SW, Goncalves LB, Dietz P. The American journal of sports medicine 2007 · PMID 17687121 · doi:10.1177/0363546507305016

Question

How accurate is the hook test for diagnosing complete distal biceps tendon rupture compared with MRI?

Design

Prospective diagnostic study with surgical findings as the reference standard.

Patients

Patients presenting with suspected distal biceps tendon injury.

Intervention

Hook test: examiner tries to hook a finger under the lateral edge of the biceps tendon with the elbow flexed and forearm supinated

Comparison

MRI

Primary outcome

Sensitivity and specificity against operative findings

Key result

The hook test was highly sensitive and specific for complete rupture, outperforming MRI in this series.

Limitations

Performed by an expert in a specialist centre, so accuracy may be lower in less experienced hands; partial tears are harder to detect.

Impact on practice

The hook test is the key clinical sign for complete distal biceps rupture; an intact hook with weak supination suggests a partial tear needing imaging.