Ludington’s Test

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Purpose[edit | edit source]

Ludington's Test is a test that assesses for a biceps tendon rupture or a tendon pathology. The Ludington’s Sign was first described in 1923 as a way to increase the ability to detect full tear of the proximal tear of the biceps tendon.[1] [2] [3]

Technique[edit | edit source]

Starting position [2][4]

The test can be performed with the patient sitting with their back straight, on a chair or stool, their back to the examiner. 

Procedure [4]

  • The patient is instructed to clasp both hands on the top of their head, allowing the interlocking fingers to support the weight of the upper limbs.
  • The examiner stands facing the patient's back in order to palpate the long head of the biceps tendon.
  • The examiner then palpates the biceps tendon and instructs the patient to alternate contraction and relaxation of the biceps muscle. It allows the maximum relaxation of the biceps tendon.
  • The patient contracts their biceps muscles by pushing down on their head. The examiner still palpates the long head tendon of the biceps feeling for tension on the tendon. The test should be performed bilaterally for comparison.

Interpretation of the results[edit | edit source]

A positive test for a rupture of the long head of the biceps is indicated by the presence of the tendon's contraction on the side not tested and the absence of the tendon's contraction on the side being tested. The inability to feel the tendon indicates a long head of biceps tendon rupture.


Rationale [edit | edit source]

The biceps tendon rupture can be either complete or partial disruption of the tendon of the biceps brachii muscle that can occur proximally or distally. Ludington’s test is a recommended position in which the differences in the contour and shape of the biceps can be observed. The biceps brachii acts as a strong shoulder and elbow flexor as well as a supinator. Placing the arms on top of the patient's head, put the shoulder and elbow in a position of flexion. Therefore, contracting the biceps tendon in this position brings out a strong muscle contraction. If the examiner is unable to palpate a muscle contraction at the biceps tendon, this could be indicative of a rupture of the long head of the biceps.         

Clinical Context and considerations[edit | edit source]

The biceps brachii muscle is involved in supination and flexion of the forearm. The majority of biceps tendon ruptures occur at the proximal insertion and almost always involve the long head. Therefore, a thorough physical examination of bilateral upper extremities should be carried out to assess for deformity, neurovascular impairment and, asymmetry. An asymmetry between the two biceps muscles results in a long head tendon tear.[7]

The examiner should also assess the shoulder and elbow range of motion in addition to testing the upper extremity strength, especially of the biceps muscle itself.[8] Moreover, he should always make sure to test bilaterally; palpate at the insertion of the biceps tendon as well as give concise and precise instructions to the patient while performing the test.

Biceps Brachii.png

Related Tests [9][edit | edit source]

  • Heuter's Sign    
  • Gilchrest's Sign    
  • Lippman's Test

References[edit | edit source]

  1. Starkey, Chad.  Ryan, Jeff.  Evaluation of Orthopedic and Athletic Injuries.  Copyright 2002.  F. A. Davis Company.  2nd Edition. Pg 479.
  2. 2.0 2.1 Magee. Orthopedic Physical Assessment. 4th Ed. 2002. 
  3. Ludington’s Sign. Available from: https://www.thieme-connect.de/products/ebooks/lookinside/10.1055/b-0034-71097 (Accessed, 2/03/ 2021)
  4. 4.0 4.1 Ludington's Test.  Available from: https://www.thestudentphysicaltherapist.com/ludingtons-test.html (Accessed, 26 February 2021)
  5. The Physio Channel. Ludington's Bicep & Shoulder Test Positive or Negative? Available from: http://www.youtube.com/watch?v=23sTljGyOXA [last accessed 5/3/2021]
  6. Ccedseminars. Ludington's Test. Available from: https://www.youtube.com/watch?v=LGlSDlFLUA0 [last accessed 5/3/2021]
  7. Elser F, Braun S, Dewing CB, Giphart JE, Millett PJ. Anatomy, function, injuries, and treatment of the long head of the biceps brachii tendon. Arthroscopy: The Journal of Arthroscopic & Related Surgery 2011; 27(4): 581-92
  8. Biceps Tendon Rupture. Available from: https://epmonthly.com/article/bicep-tendon-rupture/ ( Accessed, 05/03/2021)
  9. Hattam P, Smeatham A. Special Tests in Musculoskeletal Examination. Edinburgh: Churchill Livingstone, 2010