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distal biceps tendon rupture

The Basics 

The biceps brachii muscle inserts to the superior portion of the labrum in the shoulder and the coracoid process in the shoulder. The distal portion of the biceps brachii attaches to the radial tuberosity (forearm). The biceps brachii assists in elbow flexion and supination. 

Injuries to the distal portion of the biceps brachii can occur when a sudden eccentric load occurs, causing the tendon to detach from the the radial tuberosity and in some cases retract up the arm. An eccentric force occurs when there is sudden lengthening of the muscle while the muscle is contracted.This can occur when catching heavy objects, sudden falls or heavy weight lifting. 

Signs and symptoms 
bicep tendon rupture

Symptoms of distal bicep tendon rupture consist of immediate pain followed by swelling, bruising and possible deformity of the bicep known as a "popeye sign". Additionally, there may be weakness with elbow flexion and supination. 

The diagnosis of distal bicep tendon rupture may be made by physical examination, and advanced imaging may be performed if the diagnosis is unclear or for pre-operative planning. 


Treatment for distal bicep tendon ruptures consist of non-operative and operative measures. 

While the biceps brachii assists with elbow flexion and supination, there are several other muscles that function to flex and supinate the elbow as well. The brachioradialis is the primary muscle that flexes the elbow and the supinator muscle acts to supinate or rotate the forearm. If the brachioradialis and supinator muscles are intact, patients often do very well without operative management to repair the biceps tendon. Physical therapy should be done to strengthen these muscles and prevent further injury. 

For patients who are concerned about the appearance of the retraction of the biceps, operative management may be recommended. Additionally, surgery may be recommended for young active patients who wish the regain maximally elbow and supination strength. 

If surgical management is recommended, it is best to proceed with repair of the tendon within six weeks of the injury. While surgery can be performed for chronic bicep tendon tears, the risk of needing to reconstruct the tendon with a graft increases after 6 weeks. For patients who have significant retraction of the tendon, a reconstruction of the tendon with an autograft or allograft may be recommended. 

Bicep Tendon Repair Surgery
distal biceps tendon repair anatomy

There are various different techniques in which the distal bicep tendon can be repaired. One common technique used is called a "mini open technique" in which an incision is made in the front of the elbow and the bicep tendon is anchored to the radial tuberosity with either sutures, a button or screw. There are cases in which the incision needs to be widened in order to safely access the retracted biceps tendon, this is fairly common. 


After surgery, it is imperative to follow bracing and physical therapy protocols provided to you by your surgeon. 

For most patients, return to full sporting activities is possible by 16 weeks post op. 

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