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Distal Biceps Tendon Rupture


The biceps muscle, located along the front of the arm, allows you to bend your elbow and rotate your forearm to turn the palm upward. The muscle is attached by tendons to bones at the shoulder and the elbow. The upper end of biceps muscle transitions to two tendons that attach at two points on the shoulder. These are called the long and short heads of the proximal biceps tendon.

The lower end of the biceps muscle transitions to the distal biceps tendon, which attaches to a small bump on the radius (the forearm bone) called the radial tuberosity. Of all biceps injuries, only 3% occur at the distal insertion of the biceps muscle.

What is a distal biceps tendon rupture?

A distal biceps tendon rupture is a partial or complete tear of the tendon off the bone. Tendons do not have the capacity of self-repair. Thus, a distal biceps tendon rupture will not grow back, reattach or heal and restore lost function.

What causes a distal biceps tendon rupture?

A distal biceps tendon rupture is typically caused by an injury that involves a sudden force applied through the arm that rapidly extends the elbow from a flexed position. This can occur when lifting of a heavy load.

Who is at risk for a distal biceps tendon tear?

A rupture of the distal biceps tendon is most common in men aged 30 years and older. Risk factors include weightlifting, corticosteroids medications, anabolic steroid use, and smoking. The majority of ruptures occur in the dominant arm.

What are the symptoms?

  • a popping or snapping sensation when the tendon tears away from the bone
  • acute, severe pain in the front of the elbow
  • bunching up of the biceps muscle near the elbow leading to deformity
  • a gap at the front of the elbow where the tendon has detached
  • swelling and bruising
  • weakness when bending and rotating the elbow
  • cramping in the biceps muscle

Symptoms typically improve within a few weeks, and the elbow will still work because other muscles can take over the function of the biceps muscle. However, weakness will be obvious when flexing or rotating the forearm to turn the palm up.

A tear or rupture may be partial or complete. A distal biceps tear usually requires surgery within two to three weeks after the injury in order to restore complete function and to prevent too much tendon retraction/scarring.

How is it diagnosed?

Dr. Joe Cooper will ask how your injury occurred, discuss your symptoms, review your medical history and conduct a physical examination that will include performing specific range of motion testing, and strength testing comparing the injured arm with the uninjured arm. Imaging studies, including an ultrasound, x-rays and a MRI, may be used to confirm the diagnosis and distinguish between a complete and partial rupture.

What are the treatment options?

A distal biceps tendon rupture can be treated with nonsurgical methods and provide good results. However, this injury can cause a loss of 30-50% of strength. Therefore, surgical repair is often advised.

Nonsurgical Treatment

Older and less active patients with a distal biceps tear in the non-dominant arm may attempt nonsurgical treatment. The goal is to relieve pain and restore and maintain as much arm function as possible without surgery. Nonsurgical treatment will include rest, over the counter pain medications, and physical therapy.


For patients who desire to regain full arm strength and function, surgery to reattach the tendon will be recommended to occur within 2-3 weeks of the injury. Surgery delayed longer than 2-3 weeks could result in a less successful surgical outcome and an increased risk that surgery may not be able to restore full arm function. In these chronic cases, Dr. Cooper may recommend distal biceps tendon reconstruction with an allograft.

Various surgical procedures are available to reattach the distal biceps tendon to the forearm. Dr. Cooper will discuss with you the pros and cons of each approach. Rehabilitation will be prescribed to restore function and range of motion. The majority of patients who have surgery for a tendon tear will be able to regain full strength and motion. Surgery is safe with a low risk for complications.

Dr. Cooper is a fellowship trained orthopedic surgeon and sports medicine specialist who offers all of his patients the most technologically advanced treatments and procedures in a caring and compassionate environment.

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