Distal Biceps Tendon Rupture

The biceps muscle is extends from the shoulder to the elbow with primary function to help bend the elbow and rotate the forearm. Tendons act as attachments between muscles and bones. There are two biceps tendons that attach the biceps muscle to the shoulder bones and one tendon that attaches biceps muscle to the radius bone in the elbow. Biceps tendon rupture can occur at either the shoulder or the elbow. Biceps tendon rupture at its insertion into the elbow is called distal biceps tendon rupture.

There are two kinds of biceps tendon tears. Partial tears do not completely sever the tendon while the complete tears split the tendon into two pieces.  Most often, distal biceps tendon rupture is a complete tear. This means that the entire muscle is detached from the bone and pulled toward the shoulder. If you suffer biceps tendon rupture, you will experience loss of arm strength and inability to turn your palm down to palm up called supination. Other arm muscles will allow you to bend the elbow without the biceps muscle. However, if the biceps tendon is not surgically re-attached, significant weakness during supination will remain.      

Tendon Rupture Causes

Distal biceps tendon rupture at the elbow is usually due to a sudden violent straightening force applied to an arm that is bent. This can happen when a heavy object falls and an attempt is made to catch it with an open hand or during heavy object lifting. It can also occur during contact sports or martial arts. Risk factors for biceps tendon rupture include men over 30 years of age, smokers and users of corticosteroid medications. 

Torn Biceps Diagnosis

Usually, a biceps tendon tear can be diagnosed by the history of an injury and physical examination alone. X-rays can be useful in ruling out other problems that can cause elbow pain. Occasionally, an MRI is needed to differentiate between a partial and complete tear. On physical exam, there is bruising in the elbow and forearm. A snap or pop could have been felt at the time of injury. Swelling or a bluge in the upper part of the arm is created by the recoiled biceps muscle. Patient may have difficulty fully straightening the elbow or experience weakness with bending the elbow.  

Tendon Rupture Treatment

Nonsurgical Treatment

Nonoperative distal biceps tendon rupture treatment is a consideration for elderly and inactive patients or for those who are at high medical risk to undergo general anesthesia. It consists of gentle motion exercises, antiinflammatory medication and physical therapy. This type of treatment results in recovery of about 60% of the normal biceps tendon strength. 

Surgical Treatment

The tendon should be repaired 2 to 3 weeks after injury because restoring arm function at a later date may not be possible. Operative treatment is indicated for patients with distal biceps tendon rupture who wish to try to restore normal strength to the biceps tendon. The surgical reconstruction is associated with potential damage to the nerves and blood vessels of the elbow and hand. After the repair, the patients is splinted for a period of time and then must participate in a structured rehabilitation program for full recovery to take place.

+Dr. Kayvon Izadi