Distal Biceps Rupture

A sudden pop in the arm while lifting something heavy or forcefully pulling or catching something that is falling is often wishfully thought to be a minor tweak or sprain and expected to improve with time. The individual cautiously moves the arm and finds that they have full motion, reinforcing their hopes that nothing major was injured.

However, in the coming days and weeks, they continue to have pain and weakness with more forceful use of the arm and eventually decide to have the arm checked out, often at the prodding of a concerned spouse or friend. They may be surprised to find that they have completely torn their biceps tendon at the elbow and surgery is recommended. This injury, if left untreated results in permanent weakness, discomfort and fatigue in the arm.

Distal Biceps Rupture: What is it?

The biceps muscle is one of the main muscles in the upper arm running from the shoulder to just beyond the elbow. It is involved in bending the elbow. It also is important for rotating the forearm palm up. This muscle has two points of attachment at the shoulder and one at the elbow on the forearm bone known as the radius. With a sudden force across the elbow, this tendon can tear away from the bone. With the tendon no longer attached to the bone, the function of the biceps in bending and especially rotating the arm is lost.

Symptoms: What does Distal Biceps Rupture feel like?

A sudden pop or tearing sensation is commonly described.
There is often a change in contour or shape of the biceps muscle with more of a bulge or prominence further up the arm.
There may be bruising or swelling extending down into the forearm.
Pain with bending or rotating the arm or weakness with lifting or twisting is common.
Occasionally cramping or spasms of the biceps may be experienced.

Causes

Biceps tendon tears at the elbow are much more common in men than women and usually affect men over the age of 30. These are the result of trauma to the arm. Often the arm is forcefully straightened while the biceps is contracting. Common examples of this type of force include lifting something that is heavier than expected or catching something heavy that is falling or the arm getting pulled forcefully as in water skiing.

Risk factors

Men are much more commonly affected than women
Age over 30
Smoking history
Prior history of anabolic steroid or corticosteroid use/injections

Evaluation: How is Distal Biceps Rupture diagnosed?

Your doctor will ask you questions about your symptoms and how your arm was injured. Several physical exam tests can be done such as palpating along the biceps muscle towards the elbow. The “hook test” is done by feeling for the biceps tendon at the elbow while the shoulder is raised with the palm pointed toward your face.

X-ray: X-rays of the elbow are often done to evaluate for other potential causes of pain in the elbow such as a fracture or arthritis in the joint
Ultrasound: ultrasound can be used to visualize the biceps tendon and assess whether or not it is completely torn.
MRI: MRI is most useful if the diagnosis is not clear with physical exam and/or ultrasound or if there is a partial tear of the tendon.

Treatment

Non-operative treatment

If the tendon is just partially torn, or in patients with low functional demands, non-operative treatment may be recommended:

Rest: avoiding forceful use of the arm for 6-12 weeks while the tendon heals
Anti-inflammatories: over-the-counter NSAIDs like naproxen or ibuprofen can help reduce pain and inflammation related to the injured tendon
Physical Therapy: gentle range of motion and strengthening exercises can be used to build the strength of the tendon back up again as the pain improves

Surgery

If the tendon has been completely torn, surgery is generally recommended to optimize strength and function of the arm.
Surgery should be done as soon as possible after the injury, ideally within the first 2-3 weeks.
If surgery is delayed too long, the tendon may not be repairable and may need to be reconstructed with a tendon graft.
Surgery involves reattaching the tendon to the bone through one or two incisions near the elbow.
Risks of surgery are low and include, but are not limited to, nerve injury leading to numbness in the forearm or weakness in the hand, blood vessel damage, infection, wound healing problems, stiffness of the elbow or forearm, and re-rupture of the tendon.

Recovery: What Can Be Expected?

Surgery to repair the biceps tendon is an outpatient procedure meaning patients go home the same day as surgery. The arm may or may not be immobilized in a hard splint after surgery. A sling is often used early on after the surgery. Therapy with gentle elbow range of motion is started early after surgery depending on the repair technique and time from injury. A hinged elbow brace may be used to protect the arm. Generally, the focus of the first 6 weeks is protecting the tendon repair and regaining range of motion of the elbow. The focus from 6-12 weeks is gradually strengthening the biceps again. Activities are gradually advanced as tolerated beyond 3 months.

Arm in a brace for Distal Bicep Rupture treatment

Frequently asked questions about Distal Biceps Rupture

How do I know if I tore my biceps tendon?

If you felt a pop in your elbow or forearm, have bruising or swelling, and have pain with moving the elbow or rotating the forearm there is a good chance you injured your biceps tendon. You should seek evaluation with an orthopedic specialist who will examine you and if necessary obtain an MRI to confirm the diagnosis.

Will a torn biceps heal on its own without surgery?

Tears of the biceps tendon at the shoulder can often be successfully managed without surgery. Partial tears of the biceps tendon at the elbow can also heal with rest and therapy. Complete tears of the biceps tendon at the elbow do not heal back to the bone without surgery. There is loss of strength with elbow flexion and especially forearm rotation and often ongoing achy or cramping-type pain in the arm if the tendon is not repaired.

How soon should you have surgery for a torn biceps tendon?

Surgery should ideally be done within 2-3 weeks after the injury. Beyond this time frame it gets more difficult to reattach the tendon to the bone as it contracts and begins to scar. If too much time has passed and the tendon cannot be reattached to the bone, a more complicated reconstruction procedure can still be performed but this is more involved with a potentially longer recovery period.

How long does it take for a torn biceps tendon to heal?

Generally it takes about 3 months for the tendon to heal after surgery, but it can take several months more to fully regain strength in the arm.

How soon can I return to work after having my biceps tendon repaired?

It depends on the nature of your work. Light office-type work can often be resumed within several days. Light use of the arm can often be resumed around 6 weeks and unrestricted, heavy use at 3-4 months after surgery.

How long until I can lift weights after having my biceps tendon repaired?

It depends on the specifics of your surgery and ultimately this should be discussed with your surgeon but in general, gentle strengthening exercises are started at 6 weeks after surgery and gradually ramped up to unrestricted activities at 3-4 months after surgery.

Will I regain full function after surgery?

Most individuals who are compliant with the therapy and restrictions after surgery regain nearly normal if not normal strength, range of motion, and function after repair.

Physicians

The following physicians specialize in the treatment of Distal Biceps Rupture:

David B. Jones Jr., MD

R. Blake Curd, MD

Keith M. Baumgarten, MD

Jason L. Hurd, MD

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