A distal biceps tendon rupture is an injury where the tendon attaching the biceps muscle to the forearm bone tears near the elbow. This injury can significantly affect arm strength, particularly when bending the elbow and rotating the forearm. The biceps muscle plays an important role in lifting, pulling and rotating the forearm. When the tendon ruptures, these movements can become painful, weak or difficult to perform.
Distal biceps tendon ruptures most commonly occur during sudden lifting or forceful pulling activities and often require prompt assessment to determine the most appropriate treatment.
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The biceps muscle is located at the front of the upper arm and has two attachment points at the shoulder and one attachment at the elbow. At the elbow, the distal biceps tendon attaches the biceps muscle to the radius bone in the forearm.
This tendon allows the biceps muscle to:
Distal biceps tendon ruptures most often occur when a sudden force is applied to a bent elbow, particularly when the muscle is contracting while trying to resist a heavy load.
Common causes include:
Symptoms often occur suddenly at the time of injury and may include:
Partial Distal Biceps Tendon Tears: Partial tears involve damage to part of the tendon without complete separation from the bone. Symptoms may develop gradually or following a minor injury and can include pain and reduced strength.
Complete Distal Biceps Tendon Ruptures: A complete rupture occurs when the tendon fully detaches from the radius bone. This usually causes significant weakness, particularly with forearm rotation and lifting activities.
Diagnosis is based on clinical examination and imaging. Accurate diagnosis helps determine whether surgical or non-surgical treatment is most appropriate.
Non-operative management may be considered in selected patients, particularly those with partial tears or lower functional demands.
Non-surgical treatment may include:
*Cortisone is NOT advised due to the potential to weaken the tendon in the case of partial tears.
Partial tears can be graded based on how much damage there is to the tendon. High grade partial tears may be best treated with surgery. MRI scan is used to help make this determination. While pain may improve, complete tendon ruptures treated without surgery will result in permanent reduction in forearm rotation strength and elbow bending strength.
Surgical treatment is commonly recommended for complete distal biceps tendon ruptures in patients who wish to restore strength and function. Distal biceps tendon repair surgery involves reattaching the torn tendon to the forearm bone. This is typically performed through a small incision near the elbow. Surgical reattachment should be performed as early as possible after injury to prevent retraction and weakening of the tendon due to loss of blood flow.
Repair within 4 weeks is preferred. In longer standing tears repair can be difficult or impossible.
The tendon is secured to the bone using specialised fixation techniques. Dr Dallalana typically uses a technique utilising a small titanium button, strong suture and plastic screw. On most occasions the arm and hand may be used for light tasks immediately after the procedure.
Treatment decisions are based on several individual factors, including:
Dr Richard Dallalana provides specialist assessment of distal biceps tendon injuries to determine the most appropriate treatment pathway for each patient.
You may benefit from specialist assessment if you experience:
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