Distal Biceps Injuries
What is the distal biceps tendon?
The distal biceps tendon connects the biceps muscle in the upper arm to the radius bone in the forearm. It allows you to bend the elbow and rotate the forearm (such as turning a doorknob or using a screwdriver).
A distal biceps tendon injury refers to a tear or rupture where the tendon attaches to the forearm. It can be partial (some fibers torn) or complete (fully detached from the bone), often causing weakness and a visible deformity.
These injuries usually happen during a sudden, forceful event — such as lifting a heavy object or catching a falling weight — when the elbow is bent. The tendon tears from overload, especially if the muscle is contracting as the arm is forced to straighten.
Patients often feel a sudden “pop” in the elbow followed by pain, swelling, and bruising. Weakness in elbow flexion and forearm rotation is common. A visible bulge (known as the “Popeye sign”) may appear in the upper arm if the tendon retracts.
Diagnosis is based on physical exam findings such as weakness with palm-up lifting and a noticeable tendon gap. Imaging, like ultrasound or MRI, confirms the diagnosis and helps determine whether the tear is partial or complete.
Non-surgical treatment may be considered for partial tears or in patients with low activity demands. However, surgery is often recommended for complete ruptures to restore strength and function, especially in active individuals.
This surgery reattaches the torn tendon to the radius bone, often using sutures and small anchors, buttons, and/or screws. It restores the ability to rotate and bend the arm with normal strength and is usually done through an incision near the elbow in the forearm.
Recovery takes about 3 to 6 months. Patients wear a brace or sling briefly, followed by physical therapy to regain motion and strength. Lifting restrictions are in place for several months, with full return to heavy activity or sports around 4 to 6 months post-op.
At a Glance
Sachin Allahabadi, MD
- Board-Certified & Fellowship-Trained Sports Medicine Surgeon
- Expertise in Minimally Invasive Knee & Shoulder Surgeries
- Assistant Professor of Clinical Orthopaedic Surgery, Houston Methodist Hospital & Weill Cornell Medical College
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