Distal Biceps Tendon Tears

What is a distal biceps tear?

The biceps is the muscle on the front of the upper arm. At the shoulder it has two tendons, and at the elbow it has one, the distal biceps tendon, which attaches to a bump on the radius bone of the forearm. The biceps bends the elbow, but it is even more important for supination, turning the palm up, such as when you turn a screwdriver or a doorknob.

Distal biceps tears typically occur in men in their 40s and 50s. In a large national database study, nearly all tears occurred in men, the average age was in the mid-40s, and smoking and a higher body mass index were linked to a greater likelihood of injury.¹ They usually happen when the elbow is forced straight against a heavy load, such as lifting a heavy object, catching a falling weight or a sudden jerk.

What does it feel like?

Many people feel a pop with a sudden, sharp pain at the front of the elbow, followed by bruising down the forearm. The biceps muscle may bunch up higher in the arm (a “Popeye” bulge). You may notice weakness bending the elbow, and a clear loss of strength turning the palm up, which can be more noticeable than the loss of elbow bending.

Do I need surgery?

It depends on your needs. For most active adults, repair is recommended because the tendon does not heal back to the bone by itself. People treated without surgery usually keep decent elbow bending strength, but they lose a significant amount of strength turning the forearm and may tire faster with repeated tasks. Delayed repairs can still be done but may need a graft.

Surgery may be less valuable for older, less active people or those with significant medical risks, and partial tears can be tried with therapy first.

What happens in surgery?

Dr. Stepanyan reattaches the tendon to the bump on the radius using a small button or anchor, usually through a small incision at the front of the elbow. The operation is done as an outpatient. Nerves near the tendon are protected throughout, and numbness along the outer forearm can occur temporarily afterward.

Should I get a second opinion?

If you were told the tear is “partial” and you still have weakness, or if you have been told it is too late to repair, another opinion helps. Request a visit and mention the injury date.

Where can I see Dr. Stepanyan?

Dr. Stepanyan sees patients in Glendale, East LA and Santa Fe Springs.

What does recovery look like?

These are typical stages after a distal biceps repair. Your own plan may differ.

1. Weeks 0–2

   Protect the repair

   The elbow rests in a splint or brace with the elbow bent. Fingers, wrist and shoulder move freely to limit stiffness.

2. Weeks 2–6

   Regain motion

   You begin gentle active and passive elbow motion in a hinged brace, with straightening limits that open week by week.

3. Weeks 6–12

   Restore strength

   The brace is discontinued. Light strengthening begins, and you return to everyday activities.

4. Months 3–6

   Return to full activity

   Heavier lifting and sport resume in stages. Full strength usually returns between four and six months.

Do not lift anything heavy until Dr. Stepanyan clears you, since the repair is most vulnerable early on.

Sources

1. Distal biceps tendon ruptures: an epidemiological analysis using a large population database. Am J Sports Med. 2015;43(8):2012-2017. PubMed