Distal Biceps Rupture

A distal biceps rupture typically occurs when you’re trying to lift something heavier than your biceps muscle can handle, causing the tendon to tear away from the bone. It can also occur over time due to aging or wear and tear from activities that put a lot of strain on the biceps tendon, such as weightlifting or manual labor.

Distal biceps ruptures are typically classified into two types:

• Partial rupture: In this type, the tendon is not completely torn but is damaged. Often these can be treated without surgery with a good success rate of returning to activities. However, if it continues to cause pain or weakness, surgery may be needed.
• Complete rupture: This is when the tendon is entirely torn away from the bone. This can be treated without surgery, but may result in some weakness or continued pain. Many people elect for surgery.

When a distal biceps rupture occurs, you might feel a sudden, sharp pain in the front of your elbow. Symptoms often include:

• Swelling in the front of the elbow.
• Visible bruising in the elbow and forearm.
• A bulge in the upper part of the arm where the muscle has retracted.
• Weakness in bending the elbow or twisting the forearm.
• A feeling of a “pop” at the elbow at the time of injury.

Over time, if untreated, this condition may lead to a loss of arm strength and function.

A distal biceps rupture cannot heal on its own if it’s completely torn, as the torn tendon cannot reattach to the bone without intervention. Partial tears may heal with rest and conservative treatment, but these cases are rare. Most often, surgery is required to restore function and strength to the arm.

Diagnosis of a distal biceps rupture involves a physical examination, during which your doctor will check for pain, swelling, and changes in the arm’s contour. The doctor may also perform certain movements to assess your elbow’s function. Imaging tests, such as an MRI or ultrasound, can confirm the diagnosis by visualizing the tendon rupture.

Treatment options for a distal biceps rupture can be non-surgical or surgical. Non-surgical treatments, including rest, ice, compression, and elevation (RICE), and pain medications, may be recommended for older patients or those with low activity levels. However, surgery is often required for those who require full arm strength, including manual laborers and athletes.

Surgery for a distal biceps rupture is recommended for active individuals who rely on their bicep strength for their activities or jobs. Ideally, surgery should be performed within the first few weeks after the injury. The earlier the repair, the easier it is to reattach the tendon, resulting in a better outcome. The longer out from surgery, the harder the surgery becomes to perform as well as may delay the rehabilitation process.

The surgery involves reattaching the torn tendon to the forearm bone using small implants called suture anchors. The procedure can be performed through a single incision at the front of the elbow or two incisions at the front and back of the elbow.

After surgery, the arm is usually immobilized in a splint for a week before a gradual movement begins. Physical therapy starts around 6 weeks post-surgery, initially focusing on gentle range-of-motion exercises, progressing to strengthening exercises. Full recovery can take 3 to 4 months, but it can take longer for some people to regain full strength and flexibility.