Distal Biceps Injuries

The biceps muscle is the large muscle in the front of your upper arm. It helps you bend your elbow and rotate your forearm, so your palm faces upward (like when turning a doorknob or holding a bowl of soup). The distal biceps tendon is a strong cord-like structure that connects the lower part of your biceps muscle to the radius, one of the two bones in your forearm. This tendon allows your biceps to control movement in your elbow and forearm.

A distal biceps tendon injury happens when this tendon gets partially or completely torn. A partial tear means the tendon is still attached to the bone but is damaged. A complete tear means the tendon has fully detached from the bone. When this happens, the biceps muscle can no longer pull on the forearm properly, leading to pain, weakness, and loss of movement.

A distal biceps injury usually happens suddenly when too much force is placed on the arm. The most common causes include:

• Lifting something too heavy – especially if it is unexpected or forces your arm to straighten while you are holding it.
• Catching a falling object – trying to stop something from dropping can put too much strain on the tendon.
• Repetitive strain – over time, frequent bending and twisting of the arm (such as in sports or physical labor) can weaken the tendon.
• Getting hit in the elbow – a direct injury, like a fall or a hard blow to the front of the elbow, can damage the tendon.
• Aging and wear-and-tear – as we get older, tendons naturally weaken, making them more likely to tear.

People most at risk for this injury include men over 40, weightlifters, manual laborers, and athletes in sports like football, wrestling, and gymnastics. Risk factors include the use of anabolic steroids, smoking, and tendon degeneration. A distal biceps tendon rupture is rare.

If you injure your distal biceps tendon, you may experience:

• A sudden, sharp pain in the front of the elbow – often described as a tearing or snapping sensation.
• A “pop” or snapping sound at the time of injury.
• Bruising and swelling around the elbow and forearm within a few hours or days.
• Weakness when bending the elbow or turning the palm up – everyday tasks like lifting objects or twisting a screwdriver become difficult.
• A bulge in the upper arm (Popeye sign) – if the tendon fully tears, the biceps muscle can bunch up higher in the arm, creating a noticeable lump.
• A feeling of looseness in the elbow – like your arm isn’t as strong as before.

If you experience these symptoms, it’s important to see a doctor as soon as possible. Without treatment, a torn biceps tendon won’t heal properly and can lead to permanent weakness in the arm.

Dr. David Gazzaniga will perform a thorough evaluation to determine whether you have a distal biceps tendon tear.

Physical Examination

He will ask how the injury happened and what symptoms you are experiencing. He will check for bruising, swelling, and deformity in your arm. He will test your arm strength by asking you to bend your elbow and rotate your forearm. He may use the Hook Test, where he feels for the tendon near your elbow—if it’s missing, it could mean a complete tear.

Imaging Tests

• X-rays – These are used to check for broken bones or other injuries, but they do not show soft tissues like tendons.
• Ultrasound – This test can quickly show if the tendon is torn and how far it has moved.
• MRI (Magnetic Resonance Imaging) – This is the most detailed test and can confirm whether the tear is partial or complete, helping to decide the best treatment plan.