Distal Biceps Rupture (Biceps Tendon Tears at the Elbow)

What is Distal Biceps Tendon Tear?

It is a condition resulting from the tearing of the biceps tendon at its distal insertion, just below the elbow. This tear can be either partial or, more commonly, a complete tear.

The distal biceps tendon extends from the arm, crosses the elbow, and inserts into the radial tuberosity on the radius (one of the forearm bones). It plays a crucial role in elbow flexion (bending) and forearm supination (tightening screw motion) strength.

What Are the Causes?

A distal biceps tendon tear typically occurs following an injury involving a sudden eccentric contraction of the tendon, where the elbow is forced to straighten with weight.

What Are the Symptoms?

Patients with an acute distal biceps tear may present with pain, swelling, and bruising in front of the elbow. A visible bulge in the mid-arm may be seen due to the retraction/recoil of the biceps upward. Patients are likely to experience weakness in elbow flexion, forearm supination, and hand grip.

How is it Diagnosed? 

It can be diagnosed by your doctor after assessing your symptoms and performing a shoulder examination. Radiological imaging, such as X-rays, ultrasound, or MRI, is usually required for a complete assessment of the condition.

What Are the Treatments?

Once completely torn off, the tendon will retract/recoil upward and will not re-grow or heal. Pain, swelling, and bruising usually improve in a week or two, but residual weakness in elbow flexion, forearm supination, and hand grip are likely to be permanent.

Distal Biceps Repair surgery is generally recommended for a full return to strength and function. It involves one (sometimes two) incision(s) to retrieve the retracted tendon and repair it back to its original footprint, usually with a small implant such as a button and/or screw. This procedure is typically performed as day surgery.

Key Considerations:

• Surgical repair should ideally be performed early for optimal outcomes. Delayed presentation causes scarring and shortening of the retracted tendon, making a successful repair more challenging.
• In neglected cases, your surgeon may discuss salvage options such as tendon grafting with you.

Postoperative Care:

• Postoperatively, it is important to adhere to the rehabilitation protocol, avoiding excessive passive stretching or weight-bearing, especially in the early postoperative period.
• Strengthening exercises typically commence three months post-repair.

​Non-operative treatment can be considered in low-demand, elderly patients who can and are willing to tolerate the functional deficits.