Distal biceps tendon rupture

By Dr Maxime Cievet-Bonfils, hand, wrist and elbow surgeon in Lyon, France · Updated 2026-10-16 · Version française

Distal biceps tendon rupture is the tearing away of the tendon that attaches the biceps to the radius, in the crease of the elbow. It occurs during a sudden effort, with a snap, sharp pain and loss of strength when bending the elbow and turning the palm upwards. In an active patient, treatment consists of surgical reattachment of the tendon, which should be done quickly, ideally within two to three weeks of the injury.

What is a distal biceps rupture?

The biceps is the muscle at the front of the upper arm. At its lower end, it continues as a tendon that crosses the crease of the elbow and attaches to a bump on the radius (the radial tuberosity). This tendon bends the elbow and, above all, turns the forearm palm upwards (supination), as when lifting a piece of furniture.

The rupture mainly affects men aged 40 to 60. It typically happens when the bent elbow suddenly has to resist a load that forces it straight: catching a heavy object, lifting a load that slips. Smoking, some performance-enhancing substances and pre-existing weakness of the tendon make it more likely. The rupture is almost always complete (the tendon is entirely detached) and very rarely partial.

What are the symptoms?

• A snap or "pop" sensation in the crease of the elbow at the moment of effort
• Sharp pain at the front of the elbow, which often eases within a few days
• Bruising in the crease of the elbow and the forearm over the following days
• Deformity of the arm: the muscle moves up and forms a ball ("Popeye" sign)
• Loss of strength, especially when turning the forearm palm upwards

Because the pain decreases quickly, the injury is sometimes underestimated. Yet timing matters for the repair.

How is it diagnosed?

Diagnosis is first clinical: the examination feels for the tendon in the crease of the elbow (the "hook test") and looks for upward retraction of the biceps muscle by comparison with the other arm. An ultrasound scan confirms the rupture and measures how far the tendon has retracted. An MRI is useful if there is doubt. If you experience this type of injury, seek urgent medical advice; the SOS Mains (emergency hand unit) and hand emergencies service can direct you.

What are the non-surgical treatments?

Non-surgical treatment (rest, a sling for a few days, painkillers, then rehabilitation) is reserved for patients who are not very active, those for whom surgery is contraindicated, or some partial ruptures that cause little trouble. The elbow can still bend thanks to the other muscles, but a lasting loss of strength and endurance is usual, particularly for twisting movements.

When is surgery needed?

In an active patient, surgical reattachment is the treatment usually offered for a complete rupture. It is better to operate within the first days or weeks: after that, the tendon retracts upwards and sticks to the surrounding tissues, which makes direct repair more difficult. If treatment is delayed, a reconstruction with a tendon graft may be needed.

How is the operation performed?

Through a short incision at the front of the elbow, the surgeon retrieves the tendon and reattaches it to the radius using a fixation device (cortical button). The operation is done as a day case, under regional anaesthesia of the arm.

After the operation

• Depending on the strength of the repair, the elbow is moved straight away with no immobilisation
• Gentle everyday movements are resumed gradually; carrying loads is not allowed for several weeks
• Rehabilitation first restores movement, then strength
• It usually takes three to six months to regain full strength and return to heavy work or strength sports

Possible complications are mainly temporary irritation of a sensory nerve of the forearm (tingling), irritation of the posterior interosseous nerve, which can cause paralysis of finger and wrist straightening, and more rarely abnormal bone formation, stiffness or a new rupture. They are explained to you in consultation.

Frequently asked questions

Can I live without having the biceps tendon repaired?

Yes, the elbow remains functional, but with a lasting loss of strength, especially for repeated screwing or carrying. For an active patient, repair is generally advised.

Why the hurry?

The ruptured tendon retracts and heals in the wrong position within a few weeks. Early repair is simpler and more reliable than a late reconstruction.

The pain has gone: does that mean it has healed?

No. The pain eases quickly, but the tendon remains detached. Only an examination, completed by an ultrasound scan, can tell.

When can I go back to weight training?

Lifting heavy weights is usually only allowed after three to four months, gradually and according to your surgeon's advice.

This page provides general information. It does not replace a consultation: every situation is different.