Distal Biceps Tear

An Overview of a Distal Biceps Tear

Tears of the biceps tendon at the elbow is relatively uncommon.

The biceps is a muscle located in the front part of the upper arm that goes from the elbow to the shoulder. Tendons attach muscles to bones. Within this region of the upper arm, there are two groups of tendons associated with the biceps muscle. One group attaches the upper parts of the biceps to the shoulder blade (proximal, or upper biceps tendons), while the second group attaches the biceps to the elbow (distal, or lower biceps tendon).

The lower biceps tendon — the distal biceps tendon — can become injured from excessive loading or a violent force and can lead to tearing or ‘rupture’ of the tendon. Most often, this injury occurs among middle-aged men during heavy weight training workouts or in jobs where heavy lifting is involved. Corticosteroid medications and smoking are additional risk factors for this injury. A distal biceps tear can be very painful and most often is accompanied by a loud ‘pop’. This injury will cause pain and possibly discoloration under the skin, along with distortion of the normal contour of the skin as the muscle bunches up above the elbow.

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Symptoms of a Distal Biceps Tear

Distal biceps tears and ruptures are somewhat uncommon, accounting for about three percent of all tendon ruptures. Once a distal (near the elbow) biceps tendon tear ruptures, symptoms will appear almost immediately. Those include:

Intense pain followed by milder, throbbing pain
Swelling of the biceps area
Bruising of the biceps area
Weakness in the arm, particularly with rotating the forearm (palm-up to palm-down)
Inability to bend the elbow
Change in the normal contour of the upper arm

Diagnosis of a Biceps Tear

Dr. Millett will perform a comprehensive physical exam that includes assessing range of motion, strength, and tenderness. If the tear is suspected in the elbow, Dr. Millett will ask you to rotate your forearm against resistance and compare the strength of this maneuver with the opposite side. Additionally, X-ray, Ultrasound, or MRI may be ordered.

Treatments for a Distal Biceps Tear

Non-Surgical

Treatment for torn biceps muscles varies. While nonsurgical treatment can be used, most active individuals who experience a distal biceps rupture will opt to have surgery in order to preserve full muscle strength. Non-surgical treatment for torn biceps muscles is best suited for those who have only a partial tear or those who do not participate in physically demanding upper-body activities. Non-surgical treatment consists of protecting the arm, resting the arm in a sling, physical therapy exercises, and managing pain with common over-the-counter medications for inflammation and pain.

This fluoroscopic image shows the cortical fixation button (yellow arrow) used to fix the distal biceps tendon back to the radial tuberosity after traumatic rupture.

Surgical

If the biceps tendon tears completely, surgical repair can be a good option to restore function and to decrease pain. Dr. Millett uses a minimally invasive surgical technique to repair a distal biceps tendon tear. This is usually done right after the injury occurs and is done to reconnect the tendon to the correct location on the bone from which it has torn. For more chronic injuries, where the tendon has retracted or become severely scarred, a graft may be needed to reconstruct the torn tendon and connect it back to bone. Dr. Millett has recently written a comprehensive scientific review paper for the Journal of Bone and Joint Surgery on this topic and is highly experienced at repairing biceps injuries.

Have you experienced a distal biceps tear?

There are two ways to initiate a consultation with Dr. Millett:

You can provide current X-rays and/or MRIs for a clinical case review ($250).

You can schedule an office consultation with Dr. Millett.

Request Case Review or Office Consultation

For additional details on a distal biceps tear, please contact the office of Dr. Peter Millett.

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!