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Distal Bicep Tear

Distal Biceps Tears Overview

Elbow injuries are fairly common in athletes and the active population. A distal bicep tear, or distal biceps tendon rupture, can occur to the elbow from a blunt force trauma or excessive loading on the joint. These tears are characterized as either partial or complete. A partial tear does not completely sever the tendon, while a complete tear will sever the tendon into two pieces. In most cases, a distal bicep tear is complete. The biceps muscle is responsible for assisting the elbow in bending and the forearm in rotating. Tendons attach the muscles to the bones of the upper arm. There are two groups of tendons associated with the biceps muscle.

  • Upper biceps tendon (proximal): Attaches upper portion of the biceps muscle to the shoulder
  • Lower biceps tendon (distal): Attaches lower portion of the biceps muscle to the elbow

If a distal bicep tear occurs, many patients will lose strength in the arm and experience a decrease in arm function. The surrounding arm muscles can bend the elbow without the biceps, but they cannot rotate the forearm from palm down to palm up.

Symptoms of a Distal Bicep Tear

Once a patient experiences a distal biceps tendon rupture, pain, swelling, bruising and weakness will appear almost immediately. Many patients will hear a loud “pop” at the time of the tear. A bulge in the upper arm or a gap in the front of the elbow may also be present. Bruising and swelling in the formearm is commonly seen.

Diagnosis of a Distal Biceps Tendon Rupture

At the patient’s consultation, Dr. Waterman will discuss the symptoms and perform a physical examination. The examination will include looking for a gap in the tendon and rotating the forearm against resistance to test the supination strength. X-rays and an MRI scan may also be performed to detect any bone damage and determine if the distal bicep tear is partial or complete.
Treatment of a Distal Bicep Tear


Non-surgical measures are reserved only for patients who have a partial tear and are involved with low demand activities, typically elderly patients. These measures involve resting the arm, protecting the arm and managing pain. Patients are recommended to discuss non-surgical treatment with Dr. Waterman immediately. Many cases of a distal biceps tendon rupture require surgical repair and must be treated during the first few weeks following the injury.


Many patients will decide to have surgery following a distal bicep tear so full arm strength and function can occur. Dr. Waterman typically performs a minimally invasive procedure right after the tear to reconnect the tendon to its correct location on the bone from where it was torn. A graft may be needed in severe cases where the tendon is severely scarred or retracted.

After surgery, patients are immobilized for four weeks to protect the tendon while it is healing. Next physical therapy is used to re-establish motion and prevent stiffness. Finally strengthening exercises are used to restore normal function, and most patients are able to return to all normal activities by 12-16 weeks following the injury.

At a Glance

Dr. Brian Waterman, MD

  • Chief & Fellowship Director, Sports Medicine, Wake Forest
  • Team Physician, Wake Forest University, Chicago White Sox
  • Military affiliation/Decorated military officer and surgeon
  • Learn more

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