Distal Biceps Rupture

With an estimated incidence of 1.2 ruptures per 100,000 patients per year, distal biceps tendon ruptures are relatively uncommon. That being said, this type of injury can significantly impact the strength and function of the arm, especially during tasks and movements that involve bending the elbow or rotating the forearm. If you have sustained an injury while lifting a heavy object and are experiencing pain, swelling, and/or weakness near the elbow joint, a distal biceps tendon rupture could be the underlying cause.

At Modern Orthopaedics of New Jersey, our world-class team of elbow experts specializes in the treatment and repair of distal biceps tendon tears and ruptures. Contact us today to book an initial consultation and take the first step toward a complete and lasting recovery!

Distal Biceps Anatomy And Function

Sitting between the shoulder and the elbow joint, the biceps muscle (biceps brachii) is the large muscle located at the front of the upper arm. Actively used during a wide variety of movements and everyday tasks including lifting and carrying objects, opening doors, writing, and throwing, it contributes to the stability of the shoulder and is instrumental to the bending of the elbow (known as elbow flexion) and the rotation of the forearm (known as forearm supination).

The biceps muscle is attached to the shoulder at one end and the forearm at the other by fibrous cords of tissue known as tendons. Near the shoulder, the biceps muscle narrows into the two proximal biceps tendons (the long-head biceps tendon and the short-head biceps tendon), which attach to the top of the shoulder socket (glenoid) and the shoulder blade (scapula), respectively. Near the elbow, a single tendon attaches the biceps muscle to the forearm bone (radius)—specifically, a small bump near the elbow joint known as the radial tuberosity. This tendon is called the distal biceps tendon. If it becomes torn, this is known as a distal biceps tendon tear.

Types Of Distal Biceps Tendon Tears

Distal biceps tendon tears are categorized as either partial or full tears, depending on their severity:

Partial Tears

When a partial distal biceps tendon tear (also known as a partial rupture) occurs, the distal biceps tendon sustains damage but remains at least partially attached to the upper arm bone (radial tuberosity). These types of injuries are far less common than full biceps tendon tears.

Full Tears

Also known as a complete distal biceps tendon rupture, a full distal biceps tendon tear occurs when the distal biceps tendon detaches completely from the radial tuberosity. Once torn away from its attachment point, the distal biceps tendon will not grow back, heal, or reattach to the radius bone on its own.

Common Causes

Distal biceps tendon ruptures are typically caused by a sudden, forceful contraction of the biceps muscle, often when the elbow is forced to straighten while the biceps muscle is contracted. At Modern Orthopaedics of New Jersey, we commonly see this type of injury in individuals who lift a load that is heavier than expected, forcing the arm straight even against resistance. Less frequently, a distal biceps tendon rupture may also occur as a result of the opposite—the forcible bending of the elbow against a heavy load, which causes the tendon to suddenly tear away from the bone.

Other common causes of distal biceps tendon rupture may include:

• A traumatic injury, such as a fall onto an outstretched arm
• The performance of repetitive overhead movements
• Overuse of the biceps muscle
• Frequent carrying of heavy loads

Risk Factors

Distal biceps tendon ruptures can affect individuals of any age and background, but the following factors may increase the likelihood of sustaining this type of injury:

• Age and Sex – The vast majority of biceps tendon ruptures occur in males between the ages of 40-60.

• Smoking – Nicotine usage can negatively affect the strength and quality of tendon tissue, including in the distal biceps tendons.
• Other Elbow Conditions – The risk of distal biceps tendon rupture may increase with the presence of tendinitis or other elbow conditions or injuries.
• Excess Weight – Living with overweight or obesity can contribute to a higher likelihood of tendon injuries due to increased pressure on the joints, including the elbow joint.

Symptoms Of A Tear Or Rupture

Every case of biceps tendon rupture presents slightly differently, but common symptoms of this type of injury include:

• A popping sound or sensation near the elbow at the time of injury

• Elbow pain, swelling, and tenderness
• Bruising in the elbow or upper arm
• Weakness when bending the elbow or rotating the forearm
• A bulge in the upper arm and/or a gap near the elbow caused by the biceps muscle retracting toward the shoulder after separating from the radius bone (sometimes referred to as a “Popeye deformity”)

If you are experiencing pain, weakness, or limited range of motion in your elbow joint, our award-winning team can provide an accurate diagnosis and a personalized treatment plan that will put you on the fastest road to recovery. Contact The Elbow Center at Modern Orthopaedics of New Jersey today to learn more!

Diagnosis

When you work with the elbow specialists at Modern Orthopaedics of New Jersey, you can expect an in-depth and accurate diagnostic process. We’ll begin by taking a thorough medical history, reviewing your symptoms in detail, and performing a careful physical examination of the affected elbow and arm. If a distal biceps tendon tear is suspected, an MRI may be recommended to provide a detailed view of the tendon. Other imaging tests, such as X-rays or ultrasound, may also be ordered to rule out other possible causes of the symptoms you are experiencing.

Once a distal biceps tendon tear or rupture has been confirmed, our team at Modern Orthopaedics of New Jersey will work closely with you to develop an individualized treatment plan tailored to your specific needs, goals, and circumstances.

Treatment Options

A distal biceps tendon rupture can have a significant impact on the function of the arm. If left untreated, this type of injury is associated with an average 30% loss of strength when bending the elbow (flexion strength) and 40% loss of strength when rotating the forearm (forearm supination strength). While surgical repair is often recommended for distal biceps tendon tears, conservative treatment treatment options can also be effective, depending on the severity of the injury and the goals and activity level of the patient.

Non-Surgical Treatment

At Modern Orthopaedics of New Jersey, a conservative treatment approach may be recommended for distal biceps tendon rupture in cases where:

• A partial tear has occurred and/or the patient’s symptoms are mild.

• The patient’s activity demands are low.
• The injury affects the patient’s non-dominant arm.
• The patient’s age or health makes surgery a high-risk option.
• The patient wishes to avoid surgery.

Non-surgical treatment for a ruptured distal biceps tendon may include rest and activity modification, pain management, and physical therapy. While these treatment options will not reattach a ruptured distal biceps tendon to the bone, they can help to reduce pain and improve overall elbow function.

Surgical Treatment

Most cases of distal biceps tendon rupture require surgical repair, where the tendon is reattached to the bone. This type of surgery may be performed using minimally invasive techniques or through an open incision, depending on the circumstances. One of our highly trained and experienced surgeons will develop a personalized treatment plan and walk you through what to expect from surgical tendon repair, based on the specifics of your case.

As time passes after a distal biceps tendon rupture, the biceps tendon typically retracts toward the shoulder joint, making surgical repair more difficult. If you suspect you have torn or ruptured your biceps tendon, we strongly recommend having the injury medically evaluated as soon as possible to avoid unnecessary treatment complications.

Recovery Timeline

The recovery timeline after distal biceps repair surgery depends on a variety of factors including the severity of the injury, the type and scope of surgery performed, and the overall health and strength of the patient. After an initial period of immobilization, patients begin physical therapy to regain strength and range of motion in the elbow joint. The majority of patients can resume most normal daily activities within 1 to 2 months after surgery, but a 6 to 12-month recovery period may be required for heavy lifting and higher-performance athletic activities involving the elbow joint.

At Modern Orthopaedics of New Jersey, our renowned team of elbow experts specializes in the diagnosis and treatment of distal biceps tendon ruptures. Relationships are at the core of our professional philosophy and we are committed to a person-centered approach that ensures our patients receive exceptional care and personalized support at every step of their treatment journey.

Address elbow pain and discomfort today when you book an initial consultation at Modern Orthopaedics of New Jersey. We look forward to meeting you!