Hi, I’m Peter Denobyl, orthopedic surgeon at Modern Orthopedics of New Jersey. Today we’re discussing distal biceps tears, which are a common injuries that we see and treat in our practice. Distal biceps tears can be very painful when they happen, and they can cause weakness to flexion of the

What is a distal biceps tear?

elbow and to rotation of the forearm. In this video, I’ll guide you through the causes, symptoms, and treatment options of this problem. If you’re dealing with symptoms potentially related to a distal biceps tear, this video is for you. So, what’s a distal biceps tear? When we tear our distal biceps, the connection between the biceps muscle, which is that muscle when we make a muscle that you see right here, it’s connected to the forearm. And so, you lose the ability to powerfully turn your palm up, and also you lose a little bit of strength in elbow flexion. Now, when it first happens, a distal biceps tear can cause swelling, bruising, and a lot of pain. And so, a lot of patients who come into our practice typically will have those symptoms along with the weakness

Common causes (heavy lift, fall, sudden force)

symptoms.

So, what are some common causes of a distal biceps tear? Well, the best way to think about this is that the force has to overwhelm the strength of the connection of the tendon to the bone. When this happens, often times I’ll see patients who maybe they were helping a friend move and they had a couch on one end and it was almost too heavy and they went and lifted and all of a sudden there’s a little bit of extra force and it goes and it just overwhelms the strength of that connection and all of a sudden they hear a pop or may feel a pop. They’ll actually also see their biceps retract up the arm and you may even see like almost like a little divot in the front part of the upper arm. And so that’s the first sign or symptom of a distal biceps tear. Some additional common causes of

Key symptoms & quick self-check (“hook test”)

distal biceps ruptures are things like accidents where you’re slipping and falling and going to try to catch yourself on a countertop or maybe you fall off a bike. These sort of things are instances where there’s an overwhelming amount of force that goes right onto your biceps when you go to grab something and you feel that pop.

So, what are the common symptoms of a distal biceps tear? Very commonly, you’ll have immediate swelling, pain, and you probably will also have felt a pop in the area of the elbow. When you look at your elbow, not only will it be swollen, painful, but you also may not feel that biceps tendon, which you normally can feel in the front of your elbow. So, how do we diagnose biceps tears? When I see patients in the office with a potential for a distal biceps tear, I also start with a history, you know, understanding what ended up happening that led to this. And a lot of

How we confirm the diagnosis (exam + MRI)

times it’s that same sort of story, which is an eccentric powerful contraure, swelling, bruising in the front of the elbow, weakness to flexion of the elbow, and also supernation, turning the palm up.

On physical exam, what I end up looking for is we call this the hook test. Now, the hook test is something where you can literally stick your finger right behind an intact bicep and kind of grab it. You can even do it on yourself and kind of note that, okay, that biceps is intact. You can feel that tendon kind of doing its thing. When we go to get that finger underneath the biceps and it’s not there, that was something we call a positive hook test. Now, another common thing that we’ll do when we suspect a distal biceps tear is to get an MRI. Now, even if I’m almost 100% sure that you popped your distal biceps and it’s retracted, I want to know how far away that tendon is, for pre-operative

Non-surgical options—who they’re right for

planning purposes, I want to know how far I have to think about coming up to find that tendon. Is it coiled all the way up into the arm? Is it torn but kind of hanging out close to where it’s inserted? And that can vary from patient to patient.

So what are the different options to treat a distal biceps tear? There’s non-operative and operative options. The non-operative option is essentially just letting the swelling resolve, getting back to the function that you can, understanding that you’re going to have less strength to flexion and a lot less strength to rotating your palm upward or supernation. Now that for some patients is totally appropriate. maybe they’re not able to undergo an operation or just don’t feel like they want an operation. I would say the vast majority of my patients who come in with this problem, a distal biceps tear, do often want to get back to full strength. And so that is going to be an operative option.

Okay. So when we decide to proceed with surgery, here’s how it goes. Now in our practice, we use minimally invasive single incision techniques. What that entails is an incision right on the front of the elbow that’s about 3 cm long. That allows us access to go grasp the tendon, secure it and put it back into the bone to allow for restoration of flexion and

Surgical repair, recovery timeline & PT milestones

supenation strength. We put absorbable sutures into the skin and allow you to right away after surgery begin the process of regaining your motion.

So you had a distal biceps repair. What does your recovery look like? All my patients engage in some form of formalized physical therapy. And that’s really important to make sure early on that you get all your range of motion back for flexion, extension, pronation, supernation, and start working on strength, which usually starts around the 1 month mark. Now, it’s kind of like a staircase. We start lightweights and then bring you up slowly week by week. And usually by about 3 months, you’re doing really, really well.

Now, for the highest end of force on your distal biceps, things like pull-ups or rowing or something that really kind of is like a heavy weight on your arm, I usually will be a little bit more conservative. Make sure that we really wait for that strong strong healing to happen, tendon to bone healing by about 6 months. If you think you’ve sustained a distal biceps rupture, come on into Modern Orthopedics. We’d be happy to evaluate you and see what the next best steps in treatment are.

The bicep muscle, the large muscle at the front of the upper arm, helps to maintain stability in the shoulder joint and enables the bending (flexion) and rotational movement (supination) of the forearm. The biceps is attached by tendons from the shoulder to the elbow. The tendon that connects the bicep muscle to the radius near the elbow is called the distal biceps tendon. When it becomes torn, this is known as a distal biceps tendon tear. While far less common than a proximal biceps tendon tear (which occurs at the shoulder joint), this type of injury can impact grip strength and forearm rotation as well as the overall power of the arm.

At Modern Orthopaedics of New Jersey, our world-class team of orthopedic specialists takes an innovative and personalized approach to distal biceps tendon repair and has successfully helped numerous patients regain full arm strength and mobility after both partial and complete distal biceps tendon tears. If you are experiencing elbow pain, weakness, or difficulty rotating the forearm, a distal biceps tendon tear could be the underlying cause. Schedule an initial consultation at our state-of-the-art clinic today to receive a thorough evaluation and diagnosis as well as a treatment plan tailored to your specific situation and treatment goals.

Understanding Distal Biceps Tendon Repair

Distal biceps tendon ruptures have an estimated incidence of just 1.2 ruptures per 100,000 patients per year, making them relatively uncommon. This type of injury occurs primarily in the dominant arm of males over the age of 40 and is correlated with:

• Repetitive overhead movements
• Overuse
• Lifting heavy objects
• A traumatic injury, such as a fall onto an outstretched arm
• Tendinitis, rotator cuff injuries, and other shoulder and elbow conditions

• Smoking

Without repair, a complete distal biceps tendon tear (one that has torn the tendon completely away from the bone) will result in an average loss of 40% supination strength and 30% flexion strength. It will not regrow or reattach to the forearm bone on its own, meaning that surgical repair often offers the most promising path towards regaining your strength.

Signs Of A Torn Bicep

Every distal biceps tendon tear presents slightly differently, but common signs and symptoms of the condition include the following:

• A popping sound or sensation near the elbow
• Weakness when flexing the arm or rotating the forearm
• Bruising and/or swelling near the elbow
• A bulge in the upper arm and/or a gap near the elbow
• Pain in the affected area that is severe initially but subsides over time

After taking a thorough medical history and asking you about your mechanism of injury, one of our skilled and experienced doctors will perform an in-depth physical examination of the affected arm. An MRI or other imaging tests may also be ordered to gain a more comprehensive understanding of the injury and rule out other potential causes of your symptoms.

Once a diagnosis of a torn distal biceps tendon has been confirmed, your doctor will develop an individualized treatment plan to put you on the quickest road to recovery. If the tear is incomplete (the distal biceps tendon is still partially connected to the bone), conservative treatment options such as rest, activity modification, pain management, and physical therapy may be recommended. Surgical repair is typically the standard of care in cases where a complete tear has occurred and the patient hopes to regain full strength and range of motion. Surgery may also be considered in cases where a partial tear is severe and/or unresponsive to a non-surgical treatment approach.

How To Prepare For Surgery

Our leading team of doctors will provide you with detailed instructions leading up to and following your distal biceps tendon repair surgery. Depending on the situation, preparation for this type of surgery may involve:

• Undergoing blood work or other tests to ensure the procedure will be safe for you
• Discussing any allergies and disclosing all medications you are currently taking
• Pausing blood thinner medications for a designated period of time prior to surgery
• Fasting before surgery
• Arranging for a family member or friend to drive you home and support you immediately following surgery

At Modern Orthopaedics of New Jersey, our team is always available to respond to any specific questions you may have as you prepare to undergo a surgical procedure at our clinic.

How The Procedure Works

The purpose of distal biceps tendon repair surgery is to reattach the ruptured or damaged distal biceps tendon to the radius bone—specifically, a small bump on the radius bone near the elbow known as the radial tuberosity. This is achieved by:

• Making a small incision to locate the torn or ruptured end of the tendon
• Removing damaged or unhealthy parts of the tendon
• Placing a small metal implant known as an anchor or button into the radius bone
• Using strong sutures to reattach the tendon to the anchor
• Closing and dressing the incision

Post-Operation Care And Recovery

Immediately following surgery, your arm will be immobilized and you’ll be required to rest and ice it for several days. After this, you’ll begin physical therapy and other range of motion exercises and should be able to resume most normal daily activities within approximately 1-2 months. It will likely take closer to 6-8 months before you’ll make a full return to high-performance athletics. Your Modern Orthopaedics of New Jersey doctor will carefully monitor your progress at every stage of recovery and advise you when your bicep is ready to take on more strenuous activities.

Potential Risks And Complications

Distal biceps tendon repair is considered a safe and highly effective surgical procedure. As with any surgery, however, there is always the potential for risks and complications, which can include:

• Infection
• Bleeding
• Nerve or vessel damage
• Allergic reactions
• Tendon repair failure

To learn more about potential risks and complications based on the specifics of your case, contact Modern Orthopaedics of New Jersey today to book an appointment. We look forward to welcoming you to our state-of-the-art clinic and helping you move forward in life with renewed strength and mobility!