Distal Biceps Tendon Rupture
Distal biceps tendon rupture is a significant upper extremity injury that results in substantial weakness of forearm supination and, to a lesser degree, elbow flexion. It is far less common than proximal biceps ruptures but carries greater functional consequence. Surgical repair within 2–4 weeks of injury restores near-normal strength and function in active patients, making prompt diagnosis and referral essential. At Maryland Orthopedic Specialists, our fellowship-trained surgeons perform distal biceps repair using proven techniques with consistently excellent outcomes.
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What is distal biceps tendon rupture?
The distal biceps tendon inserts on the radial tuberosity — the rough posteromedial prominence of the proximal radius. This insertion provides the mechanical advantage for forearm supination (supination strength decreases approximately 40–50% after rupture) and contributes to elbow flexion strength (~20–30% loss).
The distal biceps tendon inserts on the radial tuberosity — the rough posteromedial prominence of the proximal radius. This insertion provides the mechanical advantage for forearm supination (supination strength decreases approximately 40–50% after rupture) and contributes to elbow flexion strength (~20–30% loss).
Mechanism of injury: The classic mechanism is a sudden eccentric load applied to a partially flexed, supinated elbow — most commonly while lifting heavy objects, catching a falling load, or during weightlifting (deadlifts, curls). The tendon fails at its insertion on the radial tuberosity, where vascularity is poorest.
Epidemiology: Distal biceps ruptures occur almost exclusively in men aged 40–60 years. Risk factors include smoking, anabolic steroid use (associated with tendon degeneration), and prior local corticosteroid injection. Complete ruptures are far more common than partial tears.
Anatomy of weakness: The biceps is the primary supinator of the forearm (ahead of the supinator muscle itself) and a secondary elbow flexor. Because the brachialis and brachioradialis compensate for flexion, supination weakness is the dominant functional deficit after rupture.
Treatment options
Non-Operative Management
Non-operative treatment (supervised rehabilitation, activity modification) is an acceptable option for: Low-demand, elderly patients with limited physical requirements. Medical comorbidities making surgery high-risk. Patients who decline surgery. Outcomes include permanent supination weakness (~40–50%), reduced elbow flexion strength, and early fatigue with repetitive overhead activities. Patients must be counseled that non-operative management will not restore full strength.
Distal Biceps Tendon Repair
Surgical repair of a completely ruptured distal biceps tendon at the radial tuberosity using a single-incision or two-incision technique. Restores full supination strength and the approximately 30% of elbow flexion power lost at rupture.
Click for more Surgical ProcedureDistal Biceps Tendon Repair (Elbow)
Primary and reconstructive repair of distal biceps tendon ruptures at the radial tuberosity, using a single-incision anterior approach or two-incision technique based on anatomy and chronicity of the rupture.
Click for moreFrequently Asked Questions
Does distal biceps rupture need to be fixed urgently?
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What is the "Popeye" sign?
Can partial tears of the distal biceps be treated without surgery?
Meet the specialists
John J. Christoforetti, MD
Orthopedic Surgery · Sports Medicine · Hip Preservation Surgery
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References
- Morrey BF, Askew LJ, An KN, Dobyns JH. Rupture of the distal tendon of the biceps brachii: a biomechanical study. Journal of Bone and Joint Surgery (JBJS). 1985;67(3):418–421. https://doi.org/10.2106/00004623-198567030-00013
- Chavan PR, Duquin TR, Bisson LJ. Repair of the ruptured distal biceps tendon: a systematic review. American Journal of Sports Medicine (AJSM). 2008;36(8):1618–1624. https://doi.org/10.1177/0363546508315045
- Citak M, Backhaus M, Seybold D, et al. Surgical repair of the distal biceps brachii tendon: a comparative study of the single-incision and the modified two-incision technique. Knee Surgery, Sports Traumatology, Arthroscopy. 2011;19(10):1752–1757. https://doi.org/10.1007/s00167-011-1469-8
- American Academy of Orthopaedic Surgeons. Distal Biceps Tendon Tears — OrthoInfo. https://orthoinfo.aaos.org/en/diseases--conditions/distal-biceps-tendon-tears (accessed May 2026).
- Bain GI, Prem H, Heptinstall RJ, Verhellen R, Paix D. Repair of distal biceps tendon rupture: a new technique using the Endobutton. Journal of Shoulder and Elbow Surgery (JSES). 2000;9(2):120–126. https://doi.org/10.1067/mse.2000.103003