Distal Biceps Tendon Rupture

What is it?

The biceps is a large muscle in the front of your upper arm. The muscle is attached by tendons, one at the top in the shoulder and one at the bottom in the elbow. 

The biceps tendon at the elbow can be ruptured. This is more common in strength athletes, bodybuilders and heavy manual workers.

After biceps tendon rupture there is usually pain in the front of the elbow, bruising and swelling. The biceps muscle itself can also rise up the arm creating a bump, which is also known as a ‘popeye’ sign.

What are the symptoms?

In distal biceps tendon ruptures, initially there is pain, swelling, bruising and stiffness. Patients often hear a ‘pop’ when it occurs and feel a ‘ping’ at the elbow.

There will also be weakness. Patients will typically have difficulty lifting objects, turning a key or twisting a screwdriver. This is because the biceps muscle is involved heavily with forearm rotation and elbow bending.

If left untreated, there can be long-standing weakness of bending and rotation power of the arm. There may also be stiffness of the elbow and cramping of the muscle itself. In low-demand individuals, however, the body often adapts and surgery isn’t always needed.

what is the treatment?

In younger or high-demand patients, surgery is required to repair the biceps tendon back onto its normal attachment. This needs to be performed within 3 weeks, otherwise repair can become difficult.

Surgery involves making a small incision in front of the elbow. The tendon is found and repaired back onto the radius bone at the elbow. After surgery, movement is initiated immediately. You will receive regular appointments with a dedicated physiotherapist to guide your rehabilitation, and full recovery is usually expected at 3 months.

If surgery is delayed, a reconstruction may be required to ‘bridge’ the repair. This is performed with a tendon from the patient’s thigh or using an allograft.

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