Key Takeaways
- A distal biceps tendon rupture is a tear of the tendon that attaches the biceps muscle to the forearm at the front of the elbow.
- A pop at the elbow, bruising, and a bulge higher in the upper arm, often called a 'Popeye' bulge, are common signs.
- Timing matters because repair is ideally done within the first 2 to 3 weeks after injury, before the tendon pulls back further from the bone.
- Waiting too long can mean a more complex reconstruction, and untreated tears can lead to lasting weakness when turning the palm up.
- Mountainstate Orthopedic Associates (MOA) provides expert tendon repair and sports medicine care in Morgantown and North Central West Virginia, so request an appointment soon after an elbow injury.
What Is a Distal Biceps Tendon Rupture?
Your biceps muscle runs along the front of your upper arm. Tendons (tough cords that connect muscle to bone) attach it at both ends:
- Proximal end: the tendons at the shoulder
- Distal end: one tendon at the elbow, which attaches to a forearm bone called the radius
A distal biceps tendon rupture happens when the tendon at the elbow tears away from the bone. These tears are not common. According to OrthoInfo's guide to biceps tendon tears at the elbow, they occur in only 3 to 5 people per 100,000 each year, and rarely in women. Men over 30 are most likely to have this injury.
How Distal Biceps Tears Happen
Most distal biceps tears come from a sudden injury. The elbow is forced straight while the arm is working hard against a load. In North Central West Virginia, that might look like:
- Catching a heavy object that is falling or slipping
- Lifting a feed bag, log, or piece of equipment that is heavier than expected
- Pulling hard on a stuck tool or dragging a deer out of the woods
- Heavy lifting at the gym or on the job site
Smoking and the use of corticosteroid or anabolic steroid medicines can also weaken tendons and raise the risk of a tear.
The 'Popeye' Bulge: What It Means
When the tendon tears away from the elbow, nothing holds the bottom of the biceps in place. The muscle pulls back toward the shoulder and bunches up in the upper arm. OrthoInfo's article on the Popeye arm bulge explains that this bulge looks like the cartoon sailor's muscle, and that a gap may be felt at the front of the elbow where the tendon used to attach.
A 'Popeye' bulge can also happen when the biceps tendon tears at the shoulder. The location of the pop, pain, and bruising helps a doctor tell the two apart.
Other Signs of a Distal Biceps Tear
- A pop at the elbow at the time of injury
- Swelling at the front of the elbow
- Bruising in the elbow and forearm
- Weakness when bending the elbow
- Weakness when turning the palm up, a motion called supination
The first pain can be intense but often fades quickly. That is why some people put off getting checked, which can affect their treatment options.
How a Distal Biceps Tear Is Diagnosed
A doctor will ask how the injury happened and where you felt the pop. During the exam, the doctor checks the front of the elbow for swelling, bruising, and a gap where the tendon should be. Simple strength tests compare how well you can bend the elbow and turn the palm up on each side.
X-rays may be taken to rule out a broken bone, and Mountainstate Orthopedic Associates offers in-office X-rays. In some cases, magnetic resonance imaging (MRI) may be used to see whether the tendon is partly or fully torn.
What to Do Right After an Elbow Injury
- Stop the activity and avoid lifting with that arm.
- Use ice and keep the arm supported to ease pain and swelling.
- Call an orthopedic office soon, even if the pain fades, since early repair has the best timing.
Proximal vs. Distal Biceps Tendon Tears
Cleveland Clinic's overview of biceps tendon rupture explains that the two types of tears are quite different.
| Feature | Proximal Tear (Shoulder) | Distal Tear (Elbow) |
|---|---|---|
| Where it happens | Near the shoulder | Near the elbow |
| Usual cause | Often repeated strain over time | Often a sudden injury with a heavy load |
| Where you feel the pop | Near the shoulder | Near the elbow |
| Need for surgery | Less likely to need surgery | Typically needs surgery to regain strength and function |
Why Timing of Distal Biceps Surgery Matters
After a tear, the tendon pulls back toward the shoulder and begins to scar. The longer it stays detached, the harder it is to bring back to the bone.
OrthoInfo states that surgery to repair the tendon is ideally done during the first 2 to 3 weeks after injury. Repair can at times be done up to 6 weeks after the injury. However, beyond 3 weeks it becomes more common to need a reconstruction, which uses a graft (a piece of donor tendon) to bridge the gap.
What Happens If a Distal Biceps Tear Is Not Repaired
Other arm muscles can help bend the elbow. Still, OrthoInfo notes about a 30 to 40% decrease in strength, mainly when turning the palm up. That can make it harder to:
- Turn a screwdriver or wrench
- Open doors or jars
- Lift and carry heavy loads at work
Nonsurgical care may be a fit for some people, such as those who are less active, have injured the nondominant arm, or have a higher risk with surgery. It includes rest, medicine, and physical therapy.
How Mountainstate Orthopedic Associates Repairs Distal Biceps Tears
Mountainstate Orthopedic Associates offers MOA's tendon repair surgery for biceps tears at the elbow. During surgery, the tendon is reattached to the forearm bone. After surgery, the arm is protected in a sling, brace, or cast for several weeks, followed by physical therapy.
Recovery After Distal Biceps Repair
OrthoInfo notes that the tendon takes more than 3 to 4 months to fully heal, so protecting the repair is important. After about 4 to 6 months, people can reasonably expect to return to heavy activities and manual labor jobs.
Meet MOA's Elbow and Sports Medicine Team
Dr. Matthew J. Schessler (hand and upper extremity), along with sports medicine surgeons Dr. Chad J. Micucci and Dr. Gregory Purnell, treat tendon injuries through MOA's sports medicine and arthroscopy services. No referral is needed, and in-office X-rays help speed up the first visit.
Get Your Elbow Injury Checked Quickly in Morgantown, WV
A pop at the elbow and a bulge in the upper arm are signs to get checked soon, since repair is ideally done in the first few weeks. Mountainstate Orthopedic Associates can diagnose the injury and guide you through repair and recovery.
If you think you have torn your biceps tendon, ask Mountainstate Orthopedic Associates about distal biceps tendon repair and request an appointment with MOA today.
Frequently Asked Questions
How do I know if I tore my biceps tendon at the elbow?
Common signs include a pop at the elbow, swelling and bruising at the front of the elbow and forearm, weakness when turning your palm up, and a bulge higher in the upper arm. An orthopedic exam can confirm the injury.
Can a distal biceps tear heal on its own?
The tendon does not reattach to the bone by itself. Some people do well without surgery, but OrthoInfo notes about a 30 to 40% decrease in strength, mainly when turning the palm up.
How soon should distal biceps surgery be done?
OrthoInfo states that repair is ideally done during the first 2 to 3 weeks after injury. It can at times be done up to 6 weeks after injury, but a reconstruction becomes more likely after 3 weeks.
How long does it take to recover from distal biceps repair?
The arm is protected for several weeks, followed by physical therapy. OrthoInfo notes that people can reasonably expect to return to heavy activities after about 4 to 6 months.
Where can I find a biceps tendon surgeon near me in Morgantown, WV?
Mountainstate Orthopedic Associates treats biceps tendon tears at offices in Morgantown, Bridgeport, and Fairmont. No referral is needed for a consultation.
