Distal Biceps Rupture

What is the Bicep?

The bicep is a muscle of two parts (bi = 2) in the arm. The bicep muscle attaches to both the shoulder and the forearm. The ‘long head’ enters the shoulder and the long and ‘short heads’ combine to form one tendon at the elbow. The tendon at the shoulder is called the proximal biceps tendon and the tendon at the elbow is called the distal biceps tendon.

Distal Biceps Tendon Rupture

Rupture of the distal biceps tendon at the elbow joint is uncommon and accounts for less than 5% of biceps tendon ruptures. There is usually some degree of degenerative change within the tendon that predisposes it to rupture and it is seen almost exclusively in males. Ruptures of the distal tendon near the elbow usually occur when an unexpected force is applied to a bent arm. This is most commonly an activity such as lifting a heavy rock or doing weights at the gym. It can also happen during sports such as a rugby tackle or a snowboarder using the arm to try to break a fall.

Without surgical repair, patients who experience complete rupture of the distal biceps tendon will notice loss of strength at the elbow. The strength will affect both the ability to bend the elbow against resistance and the ability to turn the forearm to the palm-up position against resistance (for example, turning a doorknob). Typically patients get fatiguing and pain in the elbow with repetitive use.

What are the symptoms of distal biceps tendon rupture?

The patient usually experiences sudden pain over the front of the elbow after a forceful effort against a flexed elbow. There may be a snap and the muscle may curl up into the arm. Swelling and bruising around the elbow are common. Movement usually returns over a few days and the abnormal muscle shape becomes more obvious.

What is the treatment of distal biceps tendon rupture?

There is no doubt that the best results are achieved with surgery within 3 weeks of the injury. After this time patients are still usually better off with surgery but may require a reconstruction procedure rather than a direct repair.

If the tear is incomplete then surgery may not be needed (or if the patient is elderly or has very low demands of the arm). Most patients who want more normal use of their arm will benefit from surgery to repair the ruptured tendon to the bone.

Range of motion exercises can begin as early as two weeks after surgery depending on the strength or repair achieved. Forceful biceps activity is often restricted for six to twelve months.