Distal Biceps Tendon Tears
A distal biceps tear occurs when the tendon detaches from the forearm bone at the elbow. It usually happens during an unexpected heavy load. Unlike a tear near the shoulder, it can cause a noticeable loss of strength, particularly when turning the palm upwards.
Common causes and risk factors
• Trying to hold a heavy object as the elbow straightens
• Weight training or manual work
• Age-related tendon weakening
• Smoking or steroid use may increase risk
Symptoms and signs
• A pop and sharp pain at the front of the elbow
• Bruising and swelling
• A change in the biceps shape
• Weakness with twisting and lifting
How is it diagnosed?
Examination includes specific tests for tendon continuity. Ultrasound or MRI can confirm whether the tear is complete and assess retraction.
Treatment options
Surgical repair is not always required but is commonly offered to active patients who want to restore strength. It is ideally assessed early because the tendon can retract and scar. Non-surgical treatment may suit lower-demand patients or those for whom surgery presents unacceptable risk.
When should I see a specialist?
Arrange an assessment if you have:
• A suspected new tear, ideally within days
• Visible deformity or marked bruising
• Weakness turning a key or lifting
• A delayed injury with ongoing functional loss
Frequently asked questions
What happens without surgery?
Pain usually settles, but weakness in palm-up rotation and some lifting tasks often remains.
How soon should repair be performed?
Early assessment is preferred; delayed repair can be more complex.
How long is recovery?
The repair is protected initially, then movement and strengthening are gradually progressed over several months.
What does the evidence say?
The evidence suggests a greater loss of supination (rotation) strength than flexion (bending) strength without repair and recommends early specialist discussion for active patients.
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