The distal biceps tendon starts at our biceps muscle and goes down into the elbow area and attaches onto the radius bone in the forearm (one of the wrist bones). It attaches in an area that allows us to flex or curl up our arm as well as rotate the arm (such as using a screwdriver or opening a door handle). This tendon helps your muscles bend the elbow and rotate the arm. When these functions are taken to an extreme, such as lifting something heavy, overextending the arm, or falling on an outstretched arm, the tendon can rupture or tear.
If injured, it should be fixed within four to six weeks. Otherwise, the tendon can retract and scar into place, which makes it more difficult to fix later on.
Distal Biceps Tendon Rupture FAQ
How is the distal biceps tendon most commonly injured?
A common way that a bicep can rupture is by lifting very heavy objects. This can cause the distal biceps tendon to rupture, creating a tearing sensation.
This type of injury announces itself immediately: You will experience severe pain, swelling, bruising, weakness in the elbow or shoulder, and difficulty rotating the wrist. You may also hear a popping noise at the time of injury. An unusual side effect of damage to the tendon is a bulge that may appear at the site of the injury, caused by a muscle that is no longer properly tethered by the distal biceps tendon.
A rupture is usually caused by a sudden event, but it could also be the result of a complex physiological interaction. For example, damage to the tendon is sometimes related to other conditions such as shoulder impingement, elbow tendonitis, or rotator cuff injury.
How is a rupture or tear in the tendon diagnosed?
The condition is diagnosed by a physical exam and possibly imaging. Dr. Anthony Romeo will check for the unique physical manifestations of this injury—such as the protruding muscle (sometimes called a Popeye deformity) and a gap at the front of the elbow created as the tendon ruptured. Simple physical tests can help determine whether your injury is a partial or complete tear. Depending on the damage, an X-ray, ultrasound or even an MRI image may also be needed.
Distal biceps injuries are often treated conservatively, with rest, exercise and physical therapy. If it is a complete tear, then surgery may be required.
Distal Biceps Tendon Repair
During a Distal Biceps Repair, the tendon that has moved to the front of the arm is located and pulled back down to the radius bone. A hole is made in the bone, and part of the tendon is pulled out and inserted into the hole.
To do this, a small incision in the front of the arm and the hole is then drilled. Using a special technique, we push the tendons into place and fix it there so that it heals and allows the return of full flexion strength and full rotation (supination) strength of the elbow.
Distal Biceps Tendon Repair Recovery
After surgery, you will need to wear a hinged elbow brace that will protect your arm for a month. You may experience swelling, and Dr. Romeo recommends ice packs as an effective way to provide relief during the first days after surgery. An ice pack should be applied once every one to two hours, for 20 minutes at a time. Dr. Romeo will provide specific instructions to manage any post-op pain.
Once your arm is free of the splint, you will begin physical therapy that includes range of motion and isometric exercises to strengthen the muscle and prevent contraction. The good news about surgical repair of the distal biceps tendon is that you can expect to reclaim full strength, range of motion, and rotational functionality in your arm, elbow and wrist once healing is complete. Recovery typically takes about six months.
For more information about causes and treatment of distal biceps injuries, please request an appointment with experienced Chicago orthopaedic surgeon Dr. Anthony Romeo. Call or email our office today to schedule your visit.
Want to know more? Here’s some of Dr. Romeo’s recent medical journal articles about distal biceps tendons:
Distal Biceps Tendon Repair Surgery Videos & Animations
Distal Biceps Tendon Surgery
Distal Biceps Repair Animation Video
Anthony Romeo, MD
Dr. Anthony Romeo is one of the nation’s leading orthopaedic surgeons specializing in the management and surgical treatment of shoulder and elbow conditions. His state-of-the-art practice employs minimally-invasive arthroscopic techniques to accelerate the recovery process for a range of challenging conditions.