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Elbow

Distal Biceps Tears

What is a Distal Biceps Rupture?

Distal biceps ruptures are relatively uncommon injuries that occur when the tendon attaching the biceps muscle to the forearm bone (radius) tears or detaches from its insertion point. This injury typically occurs during forceful contraction of the biceps muscle, often as a result of lifting a heavy object or performing an eccentric load on the arm. This page aims to provide an overview of distal biceps ruptures, including their causes, symptoms, diagnosis, and treatment options.

  1. Sudden Forceful Contraction: Distal biceps ruptures often occur when the elbow is forcibly straightened against resistance, such as during heavy lifting or activities that require a sudden and forceful contraction of the biceps muscle.
  2. Traumatic Injury: Direct trauma to the front of the elbow, such as a fall onto an outstretched arm or a blow to the forearm, can also cause a distal biceps rupture.
  3. Degenerative Changes: Chronic overuse or repetitive stress on the distal biceps tendon, particularly in individuals engaged in activities that involve repetitive elbow flexion and extension, may weaken the tendon and predispose it to rupture.

  1. Sudden Pain: Patients with a distal biceps rupture often report a sudden onset of pain in the front of the elbow or forearm at the time of injury.
  2. Weakness: Weakness in elbow flexion and forearm supination (rotating the palm upward) may be present, particularly with activities that require lifting or gripping objects.
  3. Swelling and Bruising: Swelling, bruising, and tenderness may develop around the front of the elbow or along the course of the biceps muscle and tendon.
  4. Popeye Sign: In complete ruptures, a noticeable bulge or deformity may be observed in the mid-upper arm, resembling the appearance of a “Popeye” muscle due to the retracted biceps muscle.

Diagnosing a distal biceps rupture typically involves a combination of clinical evaluation and imaging studies, including:

  • Physical Examination: Assessment of elbow range of motion, strength, and palpation of the biceps tendon for abnormalities, such as a gap or defect.
  • Ultrasound or MRI: Imaging studies, such as ultrasound or MRI scans, may be ordered to visualize the integrity of the distal biceps tendon, assess the extent of the injury, and identify any associated soft tissue damage or other abnormalities.

Non-Surgical Management:

  • Non-operative treatment may be considered for partial tears or low-demand patients with minimal functional impairment.
  • Rest, activity modification, and anti-inflammatory medications may help alleviate pain and inflammation, while physical therapy can focus on strengthening and range of motion exercises.

Surgical Intervention:

  • Primary Repair: Surgical repair of the distal biceps tendon involves reattaching the torn tendon to its insertion point on the radius using sutures or fixation devices.
  • Timing: Early surgical intervention, typically within two to three weeks of injury, is recommended to optimize outcomes and prevent tendon retraction and scarring.
  • Technique: Surgical repair can be performed through various approaches, including a single-incision anterior approach or a two-incision anterior and posterior approach, depending on surgeon preference and patient factors.
  • Rehabilitation: Postoperative rehabilitation typically involves a period of immobilization followed by a progressive rehabilitation program focused on restoring elbow range of motion, strength, and functional activities.

Recovery from a distal biceps rupture depends on various factors, including the extent of the injury, chosen treatment approach, and individual patient factors. Physical therapy plays a crucial role in postoperative rehabilitation, focusing on restoring elbow range of motion, strength, and functional capacity while protecting healing tissues and minimizing the risk of complications. Rehabilitation protocols are tailored to the specific surgical procedure and patient needs, with a gradual progression of exercises aimed at achieving a safe return to activities and optimizing long-term outcomes.

Why choose Dr. Christian Cruz?

If you or a loved one has suffered a distal biceps tear, schedule a consultation with board-certified elbow surgeon Dr. Christian Cruz. Practicing in Alexandria, Arlington, and Lanham, Dr. Cruz is recognized for his expertise in treating elbow injuries and can help you regain strength and function. Contact us today for comprehensive orthopedic care and to schedule your appointment.

At a Glance

Dr. Christian Cruz

  • Fellowship trained in Sports Medicine and Shoulder Surgery
  • Expertise in complex knee and shoulder reconstruction
  • Assistant Professor of Orthopaedic Surgery at Uniformed Services University School of Health Sciences
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