What to Know About a Distal Bicep Tear (And What it Feels Like)

You’re carrying something and feel a sudden pop in the front of your elbow followed by immediate pain and a deformity in your upper arm. What did you do?

It’s possible you tore the distal biceps tendon, also known as a distal bicep tear. This is a partial or complete tear of the tendon of your bicep muscle where it inserts on your upper forearm at your elbow. It’s a painful injury that typically requires surgical treatment.

At Town Center Orthopaedics, we have experience treating distal biceps tears. If you sustain this injury, you can count on our team for high-quality, state-of-the-art treatment that will restore pain-free function to your injured arm.

Anatomy of the Distal Biceps Tendon

Middle aged man in workout clothes holds injured elbow while waiting for the doctor.

Most people are familiar with the bicep muscle, which is located in the front of the upper arm. You might not know, though, how the muscle works and supports your arm’s function.

Biceps have two tendon connections around the shoulder: one that runs through the shoulder joint and one that connects to the front of the shoulder blade. These connections are known as the proximal connections. At the other end of the humerus (upper arm bone), there is only one connection, the distal connection. This connection attaches the bicep to the forearm at a bump, called the bicipital tuberosity, on the radius, one of the two forearm bones.

The biceps are the muscles that allow us to bend (flex) our elbows; for example, when you need to scratch your nose. However, because the biceps have support from other muscles when you need to flex, it’s possible to still bend your elbow even when one of the tendons tears.

However, the distal biceps tendon is crucial in maximizing your elbow flexion and rotation strength (such as that needed to turn your palm up; also known as supination.) A distal bicep tear can limit your ability to do this, making it difficult to perform even simple tasks like turning a screwdriver.

What Causes a Distal Bicep Injury?

Most distal bicep tears are caused by carrying something heavy with your elbow bent; for example, weightlifters and furniture movers are prone to this type of injury.

Catching a moderately heavy object while it falls can also cause a torn bicep tendon. This includes grabbing onto something to keep yourself from falling or pulling yourself up. Pulling someone or something toward you rapidly or with great force can also tear the bicep tendon.

Distal bicep tears typically occur in tendons that already have some degree of injury or degeneration, a condition called tendinosis. The weakened tendon simply cannot handle the strain being put on it. It’s more common in men, especially those who smoke or who are in poor physical condition, but athletes — in particular, bodybuilders who continually lift heavy objects — are also vulnerable.

The Symptoms of Distal Biceps Tears

If you tear the distal biceps tendon, you will know it. You will feel, and maybe even hear, a “pop” in the front of your elbow and the palm side of your upper forearm. This is typically very painful.

Other signs of a tear include:

  • Swelling around the front of the elbow
  • Bruising on the inner elbow and upper forearm
  • Deformity of the biceps; when the muscle is no longer connected to the elbow, the muscle shortens and gives the appearance that the bicep has migrated up the arm.

Keep in mind that even though the tendon is partially or completely torn, you will still have function in your arm. It will be painful, and you may have difficulty with some tasks, but because multiple muscles and tendons work together, you’ll maintain a degree of function and mobility.

To see what a distal biceps tear injury looks like, check out the video below. WARNING: Some may find this video disturbing. It is a compilation of videos showing athletes tearing their distal biceps tendon during training or competition.

Treating Biceps Tendon Injuries

If you think you have torn your distal biceps tendon, seek care as soon as possible. The injury isn’t necessarily an emergency, but prompt response makes treatment more effective and supports faster recovery.

Most orthopaedic doctors can confirm a biceps tendon tear by hearing what happened and conducting a physical exam. They may order X-rays to rule out any fractures or other injuries that could be contributing to your symptoms. In some cases, an MRI might be necessary for a conclusive diagnosis.

Initial treatment focuses on pain management, usually through over-the-counter pain relievers. Because the tendon will not heal and reattach to the radius on its own, surgery is usually required. While you wait for surgery, you may need to wear an arm sling for support and immobilization.

Having surgery to reattach the tendon is almost always recommended for active individuals. However, in cases of a partial tear, or for patients who are mostly sedentary and willing to live with the weakness in their arm, nonsurgical treatment is an option. This usually involves physical therapy to restore some strength to the elbow.

Surgery to Repair Torn Tendons

The primary goal of surgery to repair a distal biceps tear is reattaching the end of the torn tendon to the radius bone and holding it in place long enough for the tendon to heal. This can be accomplished in several ways:

  • Sutures in the tendon can be passed through drill holes in the bone and tied.
  • Suture anchors can adhere the tendon to the bone.
  • Screws can secure the tendon in a hole created in the bone.

In any case, this type of surgery is minimally invasive. It only requires two incisions, one in the front of your elbow and one in the back, or just one incision in the front of your elbow, depending on the method used.

What to Expect After Surgery

After tendon reattachment surgery, it’s normal for your elbow to feel tight. You also won’t be able to straighten it — and that’s normal.

On average, it takes at least three months for tendons to fully re-adhere to the bone. Until that happens, putting too much force on the tendon, either by straightening the elbow past its limit or by using your biceps for lifting relatively heavy objects, can pull the tendon off the bone and disrupt the repair.

To keep this from happening, you’ll likely need to wear an elbow brace during the initial phase of your recovery. Physical therapy is also a key part of recovery. And while complete recovery can take upwards of six months, in most cases the elbow will have recovered enough that you will be relatively asymptomatic within 3-4 months.

The Takeaway

A distal biceps tear is a common elbow injury in active people. It often occurs while lifting and is associated with an acute pop, pain, swelling, and frequently, a concerning deformity. These injuries nearly always require surgery, but fortunately, the postoperative recovery is relatively simple, straightforward, and usually predictable.

If you have injured your elbow in any way, don’t wait to get treatment. Call Town Center Orthopaedics at 703-435-6604 or request an appointment here.


Jeffrey H. Berg, M.D.

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