Distal Biceps Tendon Rupture
The biceps muscle is attached by tendons at both ends (the shoulder and the elbow). Either end can be torn as a result of trauma and degenerative change. This page discusses the distal biceps tendon rupture (at the elbow).
The triceps is the large muscle in the back of the arm which is primarily responsible for extension (straightening) of the elbow. It is important for power tasks such as performing a bench press or a pushup, or even simple everyday tasks like straightening the elbow to hold an object overhead. Ruptures of this large powerful muscle and tendon are extremely rare, but may happen if a large flexion force is applied right as the triceps is contracting to resist this force (such as during a fall).
Distal Biceps Tendon Rupture Symptoms
Distal biceps tendon ruptures almost always occur in men between age 40-60, though they are becoming increasingly recognized in women. Complete ruptures are fairly dramatic and occur when the elbow is forcibly extended while the patient is trying to keep it flexed (i.e. a heavy weight being placed into the patient’s hand that he or she is unable to carry). Very often the pain is sudden, severe, and an audible “pop” may be heard. This often is followed in the next few days by swelling, bruising, and an abnormal contour to the front of the elbow and arm. Patients may even notice some numbness and tingling running down the forearm. In very lean individuals, this diagnosis is obvious on history and physical examination but in patients with much larger arms or where a partial tear is present, additional testing such as an MRI scan may be required to establish the diagnosis.
Image 1: Clinical photo of a construction worker with a distal biceps rupture
Image 2: Sagittal MRI image of a man with distal biceps rupture
Distal Biceps Tendon Rupture Treatment
The best treatment for a partial distal biceps rupture is several months of rest from heavy lifting. However, if the symptoms do not improve or in the event of a complete distal biceps tendon rupture, the best treatment is surgical reattachment of the ruptured tendon. Repeated studies have shown significantly better arm strength, endurance, and overall functionality in patients who have the tendon repaired compared to patients who do not. The diagnosis of a complete rupture must be made early because the tendon becomes significantly more difficult to repair after a few weeks have passed.
Surgical Repair of Chronic Distal Biceps Tendon Rupture
Bruce Leslie, M.D. and the physicians at NWOA have performed the largest published series of biceps tendon repairs in the world. Some of Dr. Leslie’s published articles on biceps tendon ruptures are listed below.