Distal Biceps Tendon Rupture
The biceps muscle at the front of the upper arm is attached by two tendons to the shoulder and one tendon to the elbow. The biceps muscle enables you to bend your elbow and rotate your forearm to turn your palms upward. A distal biceps rupture occurs when the tendon that attaches the biceps muscle to the radius bone, the bone in the lower forearm, tears away from its attachment point.
Distal biceps tendon rupture is relatively uncommon, affecting only 3 to 5 people per 100,000 per year, and primarily occurs in middle-aged men. A rupture can significantly impact arm function, particularly in activities requiring strength, such as lifting or twisting motions. Once torn off the bone, the distal biceps tendon will not grow back and heal without surgical intervention.
Distal biceps ruptures commonly result from a sudden and forceful load placed on the arm, particularly when the elbow is flexed. Common scenarios include lifting heavy objects typically in weightlifting, falling on an outstretched arm, or engaging in activities that require a sudden, intense contraction of the biceps muscle.
Risk factors for a distal biceps rupture include:
- Smoking
- Overuse leads to degeneration of the tendon
- Age
- Corticosteroids degenerate the tendon strength
- Gout
- Diabetes
- Chronic kidney disease
- Increased BMI
The typical symptoms of a distal biceps rupture include:
- A sudden, sharp pain in the elbow at the time of injury.
- A noticeable “pop” or tearing sensation.
- Weakness in the arm, particularly in bending the elbow or rotating the forearm.
- A visible change in the shape of the biceps muscle, often described as the muscle appearing to bunch up near the shoulder (also known as the “Popeye” deformity).
- Bruising or swelling around the elbow.
Dr. Zahab Ahsan will discuss your symptoms and how the injury occurred. He will perform a physical examination, during which he will feel the distal tendon to check for the characteristic signs of the injury such as pain, weakness, and loss of strength. There are also several clinical tests he may use to check for a complete distal biceps rupture. To confirm a rupture he may order imaging studies, such as an MRI or ultrasound, to determine the extent of the tear.
Treatment options depend on the severity of the rupture and the patient’s activity level.
- Conservative, non-surgical treatment, including rest, bracing, NSAIDS anti-inflammatory medications and physical therapy can treat pain and help to regain strength. Conservative management is a viable option for less active individuals and for patients with a partial tear. If results are unsatisfactory, surgery will be suggested.
- Surgical repair is often recommended for complete ruptures and for those who require full arm strength and function for their daily activities or occupation. Surgical repair involves reattaching the tendon to the bone in forearm using suture anchors and bone tunnels.
Surgery is an anatomic repair aimed at restoring normal anatomy and function by rebuilding or stabilizing the tendon. If the tendon is of poor quality, a tissue graft may be necessary to augment the tendon.
Surgical repair should be performed within the first 2-3 weeks after the injury, because waiting can allow the muscle to scar and shorten which can make it restoration of full function impossible.
The goal of surgical repair of a distal biceps tear aims to restore strength and function to the arm, enabling patients to return to their usual activities and minimize the risk of long-term complications.
Dr. Ahsan utilizes a single incision onlay technique to secure the biceps tendon efficiently to the radial tuberosity.
Recovery from a distal biceps rupture, particularly after surgery, typically involves a period of immobilization followed by physical therapy to restore strength and flexibility. Full recovery can take 3-6 months. A structured rehabilitation program is crucial for optimal outcomes. Most patients can reasonably expect restoration of full range of motion and strength.
Understanding the signs and symptoms of a distal biceps rupture and seeking prompt medical attention can lead to better treatment outcomes and a quicker return to normal activities.
Dr. Zahab Ahsan is a Fellowship trained, dual board-certified orthopedic surgeon and sports medicine specialist in Naperville, Illinois. He is committed to guiding his patients to a complete recovery and a life without pain or restrictions through innovative treatments and minimally invasive arthroscopic surgery of the knee, shoulder, elbow, and ankle. Dr. Ahsan’s high level of patient care is guided by his experience providing sports medicine care to professional athletes of the NBA, NFL, MLB, NHL, MLS, and U.S. Olympic team. He specializes in joint preservation procedures which include modern cartilage restoration techniques and biologic therapies (PRP, Stem Cells) for bone, cartilage, tendon, and ligament repair. Contact him to schedule a consultation at his Naperville or Woodridge office.
References
- https://orthoinfo.aaos.org/en/diseases–conditions/biceps-tendon-tear-at-the-elbow/
- Jaschke M, Rekawek K, Sokolowski S, Kolodziej L. Distal biceps tendon rupture: a comprehensive overview. EFORT Open Rev. 2023 Nov 1;8(11):865-873. doi: 10.1530/EOR-23-0035. PMID: 37909692; PMCID: PMC10646517.
At a Glance
Dr. Zahab Ahsan
- Board Certified & Fellowship-Trained Orthopedic Surgeon
- Former Assistant Team Physician for the NY Knicks
- Castle Connolly Top Doctor
- Team Physician for Chicago Fire FC
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