Julian Carlo, MD - Hand & Upper Extremity Surgeon

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a diagram explaining distal biceps ruptures

Distal Biceps Tendon Rupture

What is it?

A distal biceps tendon rupture is a tear in the fibers of the biceps tendon where it inserts at the elbow.

What causes it?

A sudden and forceful eccentric contraction of the muscle (contraction of the muscle as the elbow extends) overwhelms the muscle-tendon-bone unit, causing rupture.  About 95% of ruptures occur in men, and they tend to occur in those in their 40s. Weightlifters and those prone to tendon degeneration, such as smokers and steroid users, are more likely to be affected.

What are the symptoms?

The rupture is felt as a painful “pop” in the elbow that occurs typically during lifting activities. Swelling, bruising, and a prominence of the biceps muscle, nicknamed the “Popeye deformity,” typically follow. The elbow will be painful  and weak to move and use.

How is it diagnosed?

A history and physical exam are usually sufficient to diagnose the condition. The findings of tenderness, bruising, and Popeye deformity are characteristic. The examiner can also try to hook the tendon at the elbow with a finger; an absent tendon indicates a ruptured tendon. Weakness of the elbow and forearm occurs, reflecting the functions of the biceps muscle. It’s rupture results in loss of elbow flexion strength of about 20-30% and supination (palms up) strength of 40% compared to the normal side. Elbow xrays are typically  normal. MRI is not usually obtained, but is helpful in cases of uncertain diagnosis, partial injuries, and chronic injuries.

How is it treated?

Nonoperative treatment is a consideration for this condition.  The result of nonoperative management of complete ruptures is a pain free elbow with about 80% of elbow flexion strength, 60% of forearm supination strength, and 50% of supination endurance.   For those with lower demands or who wish to avoid surgery and its risks, nonoperative management provides a satisfactory outcome.  Surgical treatment of a rupture consists of reattachment of the tendon end into the radius bone at the elbow. The result of surgical treatment is a pain free elbow with near normal strength (95% of elbow flexion strength and 90 percent of supination strength). Some patients have incomplete, or partial distal biceps tendon tears. The challenge with treating partial tears conservatively is that they can continue to be painful with use, and therefore most sufferers tend to elect surgery. A partial tear is treated by surgical release and then reattachment as if it were a complete tear.


After most surgeries, immediate range of motion is permitted. Therapy is typically recommended. Lifting and strengthening are initially restricted, but begin progressively around week 6. Return to normal activity is typically around 3-6 months, with activities that involve maximal lifting restricted till about 6 months.

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