Distal Biceps Tendon Rupture.

The biceps is one of the main muscles on the front of the arm that assists us in bending the elbow and rotating the forearm. The muscle attaches to the forearm bone (the radius) through a tendon. A distal biceps tendon rupture is a tear of the tendon so that the biceps muscle is no longer connected to the forearm bone. As the main function of the biceps is to provide strength whilst bending the elbow and turning the forearm, ruptures result in weakness and pain when performing these movements.

 
bicep tendon rupture treatment

What causes a distal biceps rupture?

Ruptures of the distal biceps tendon are almost always caused by a sudden injury to the elbow. This can happen when lifting objects that are too heavy, resulting in the elbow being forced straight when the biceps is stretched. Tendon ruptures are more common in males ages 30-50 because the tendons start to gradually weaken after the age of 30, whereas the muscles can remain relatively strong and hence can overload the tendon.

How is a distal biceps rupture diagnosed?

Most distal biceps ruptures are associated with a single, acutely painful, injury whilst lifting. Often the injury is accompanied by a ‘pop’ or snapping sound with instant bruising and swelling, many patients attend A&E straight after the injury. Usually Mr Moverley can diagnose a distal biceps rupture with a combination of clinical examination and a careful assessment of your symptoms. Further diagnostic tests are used for confirmation and to plan treatment.

  • X-rays may be obtained to rule out other injuries such as a fracture. As a distal biceps rupture is a soft tissue injury it cannot be seen on plain x-rays.

  • Ultrasound can be used to confirm the diagnosis.

  • MRI is particularly useful in cases where there has been a delay to diagnosis or there is diagnostic uncertainty.

Treatment options

Mr Moverley will tailor your treatment specifically to the cause of your symptoms, whilst taking into account your expectations and medical history.

Non-operative Management

Non-operative treatment is considered for lower demand patients or in patients where there has been a significant delay to diagnosis and symptoms are improving. Other muscles around the elbow can compensate for a torn biceps and patients will often achieve adequate function with non-operative measures. Possible non-operative options include:

  • Rest, activity modification, and simple pain relief can provide good benefit, particularly early after the onset of symptoms.

  • A focused physiotherapy program to strengthen the muscles around the elbow can prevent any further stiffness and help regain range of motion and strength.

Surgical Management

Surgery should be considered in younger and higher demand patients. With time the biceps retracts further into the arm,and can become difficult to reattach to the bone. Hence it is recommended this injury is recognised and treated soon after the event. The aim of surgery is to reattach distal biceps tendon to where it has been torn from on the radius, in order to optimise elbow function in the long-term.