Sudden sharp pain in the upper arm, heard with a snap. A bulge in the lower arm clear upon inspection. When young adults lift very heavy weights, they may experience this sort of tear.

Observe for a peculiar "misplacement" of the bicep upon flexion of the arm, as if the bicep has sunk down to the elbow. To put it more specifically, "Observe for lower arm bulge occuring from muscle belly of the biceps retracting into lower arm after proximal anchor tears loose (Essentials 123)."

Ludington's Test. Direct patient to flex the afflicted arm. Inspect for tear.

Check for ecchymosis on mid to lower arm where the blood might have drained. Palpating the bicipital groove will elicit pain with the arm in 10° internal rotation.

Rule out, not diagnose, a fracture with axillary and AP radiographs. Order an arthrogram if unsure if it is a rotator cuff tear—implied by patient's previous history of shoulder pain.

Launch a therapy program utilizing range of motion (ROM) and normal elbow flexion strength. Consider an arthrogram for patients with history of shoulder pain to rule out rotator cuff tears. Surgery with means of tendon repair for extra strength may tremendously help afflicted youth and those with harsh pain.