Distal Biceps Tendon Injury

A distal biceps tendon injury occurs when the tendon that attaches the biceps muscle to the forearm bone becomes strained or torn at the elbow.

This tendon plays an important role in bending the elbow and rotating the forearm (such as turning a screwdriver or opening a jar). When injured, it can lead to pain, weakness and difficulty performing everyday tasks.

In some cases, the tendon may partially tear. In more severe injuries, it can rupture completely, often following a sudden force such as lifting something heavy or catching a falling object.

Early assessment is important, particularly in complete ruptures, as this can affect long-term strength and function.

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Diagnosis is usually made through a clinical assessment, including a discussion of how the injury occurred and examination of elbow movement and strength.

In many cases, a tendon rupture can be identified on examination alone.

Imaging such as ultrasound or MRI may be used to confirm the diagnosis, assess the extent of the injury, and guide treatment decisions.

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Treatment depends on the severity of the injury and your functional requirements.

Non-surgical treatment may be appropriate for partial tears or lower-demand patients and may include:

• Rest and activity modification
• Physiotherapy to restore movement and strength
• Pain relief where appropriate

Surgical treatment may be recommended for complete ruptures or when strength and function are significantly affected. Surgery involves reattaching the tendon to the bone to restore function.

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When surgery is recommended, the procedure involves reattaching the torn tendon to the bone at the elbow.

This is typically performed as a day-case procedure. The tendon is secured back to its attachment using specialised techniques to restore strength and function.

The aim of surgery is to regain as much strength and movement as possible, particularly for activities requiring lifting or forearm rotation.

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Following surgery, the arm is usually supported in a sling for a short period.

Recovery typically involves:

• Gradual return to movement under guidance
• Physiotherapy to restore strength and flexibility
• Avoiding heavy lifting in the early stages

Recovery timelines vary, but:

• Light activities may resume within a few weeks
• Strength gradually improves over several months
• Full recovery can take several months depending on the severity of the injury

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As with any surgical procedure, there are potential risks, although these are uncommon.

Possible complications include:

• Infection (around 1%), usually treated with antibiotics
• Swelling or stiffness, which may take time to settle
• Scar sensitivity
• Nerve irritation or injury (rare)
• Ongoing weakness or incomplete recovery of strength
• Re-rupture of the tendon (uncommon)
• Residual discomfort around the repair site

Very rarely, a condition known as complex regional pain syndrome (CRPS) can occur, leading to prolonged pain and sensitivity.

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You should seek medical advice if you experience sudden elbow pain, weakness, or difficulty using your arm following an injury.

Early assessment is particularly important if a tendon rupture is suspected, as timely treatment can improve recovery and long-term strength.

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