TILT Sign

What is the "TILT Sign" used for?

• Partial Tear of Distal Biceps Tendon

How to perform the "TILT Sign"?

• The patient is seated with the elbow flexed to 90°. 
• The examiner firmly palpates the radial tuberosity (where biceps inserts into the radius) just distal to the radial head (about 2.5 cm [1 inch] distal) while supinating and pronating the forearm. 
• In reality, the tuberosity can only be palpated when the arm is in full pronation

What is the positive result?

• A positive test is indicated by tenderness over the lateral (radial) aspect of the tuberosity (TILT) only in full arm pronation. 
• This indicates a partial tear of the distal biceps tendon.