Distal Biceps Tendon Tear

The notes on this page are written as a source of information to both patients and health professionals. It is a general overview and its content should not be seen as direct medical advice. Further information regarding diagnosis and treatment specific to your condition can be made via a consultation with Dr Amaranath.

Anatomy of the Biceps

The biceps is a prominent muscle in the upper arm which is formed by the joining of the short and long head. The heads merge at the mid upper arm to form the biceps muscle belly. Distally it reforms into a tendon which attaches to the radial tuberosity in the proximal forearm.

What is a distal biceps tendon injury?

This is where the distal biceps tendon detaches from the radial tuberosity. The detachment can be complete or incomplete (meaning some part of the tendon is still attached).

The injury if not treated surgical can lead to lumping of the biceps tendon in the arm, along with a loss of power in supination (rotation of the forearm outward) and flexion of the elbow by around 30-40%.

What causes a distal biceps rupture?

The injury is most commonly caused by an elbow which is moving from a flexed to an extended position (eccentric biceps muscle contraction). This can occur while doing biceps curls or lifting heavy objects. There are certain factors such as smoking and steroid use that may increase the risk of tendon injury.

What are the preferred Investigations/Imaging?

  1. Ultrasound elbow – This is not as sensitive as an MRI, but in patients where an MRI may be contraindicated it serves as a reasonable imaging choice to help in the diagnosis of tendon injury.

  2. MRI (FABS view) – This is the best form of imaging to identify a distal biceps tendon tear and also assess its degree of retraction. The MRI should be order so as the arm in a position of shoulder flexion, abduction and forearm supination (FABS view).

What are the treatment options?

  1. Non-operative – This is commonly reserved for patients who have a low level of activity and function of their affected arm. It involves initial analgesia and a graduated physiotherapy exam.

  2. Distal Biceps Repair – In most active patients this will be the treatment of choice. It involves making an incision in the forearm, retrieving the torn tendon and reattaching it to its insertion on the radial tuberosity.

  3. Distal Biceps Reconstruction – In cases where the tendon injury is chronic (greater than 6 weeks) a reconstruction rather than a repair would be recommended. This involves a larger incision and the use of a tendon graft to replace the non-viable, retracted chronic biceps tendon. The graft is anchored onto the radial tuberosity (bone) and weaved through the proximal muscle belly.What does the rehabilitation/recovery involve?

What does the rehabilitation/recovery involve?

To find out more about rehabilitation and recovery after elbow surgery please see our Rehabilitation Protocols here.