Distal Biceps Tendon Rupture

Tears of the biceps tendon at the elbow are not common, and generally occurs suddenly in a traumatic fashion. To restore arm strength to near normal levels, surgery to repair the tendon is often recommended.

Anatomy and Pathophysiology

The biceps muscle has both proximal (shoulder) and distal (elbow) attachments. The attachment at the elbow is known as the distal biceps tendon. Biceps tendon tears can be either partial or complete. Nearby arm muscles can compensate for an injured biceps tendon, albeit with compromised function.

Signs and Symptoms

A “pop” at the elbow occurs when the tendon ruptures, with subsequent pain, swelling and ecchymosis. Weakness with elbow bending and forearm supination (rotation) results, as does a bulge in the front of the arm due to the retracted, shortened biceps muscle.

Physical Examination and Work-up

On examination, a palpable defect is felt where the tendon once attached. Pain or ecchymosis at the rupture site may still be present. Supination and elbow flexion strength is likely diminishes relative to the opposite arm.


X-rays assess the elbow joint and for any concomitant bony injury. MRI relays the integrity of the distal biceps tendon and, if retracted, its new location.

Management of Distal Biceps Tears

Surgery to reattach the tendon is often recommended to enable restoration of full arm strength and function. Nonsurgical treatment may be considered in older adults or those who full function of the limb is not necessary or medical history places a patient at higher risk for complications during surgery.

Nonsurgical Treatment

Nonsurgical treatment focus on relieving pain and maintaining as much arm function as possible with guided physical therapy.

Surgical Treatment

Surgery to repair the tendon should be performed during the first 2 to 3 weeks after injury. After this period of time, the tendon and biceps muscle begin to scar and shorten, and restoration of function becomes less possible. Several techniques to reattach the distal biceps tendon to the forearm exist, and patient and surgeon pre-operative discussions guide these choices. Guided rehabilitation is an important component of optimal recovery from a distal biceps repair.

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