Treatment of Biceps Tendon Rupture (Distal Biceps Rupture)

The biceps muscle is an important muscle that extends from the shoulder to the elbow, responsible for both bending the arm (flexion) and rotating the forearm outward (supination). The rupture of this muscle’s lower (distal) tendon, located at the elbow, usually occurs as a result of sudden trauma. This condition is called a “distal biceps rupture” and typically occurs during activities like heavy lifting, sudden loading, or abrupt pulling motions.

Following the tendon rupture, patients often describe a sudden “popping” sensation, pain and swelling in the elbow, and a noticeable distortion in the muscle’s shape. The loss of strength in the arm is especially evident during the motion of turning the palm upward (supination). Bruising around the elbow and the upward retraction (displacement) of the muscle are typical findings.

Distal biceps rupture is most commonly seen in men and occurs more frequently in the dominant arm (e.g., the right arm for a right-handed person). Diagnosis is readily confirmed through a clinical examination and MRI (Magnetic Resonance Imaging).

Surgical treatment is generally recommended to fully restore muscle strength and function. A non-surgical (conservative) treatment option may be considered for some elderly patients or those with low physical demands; however, the resulting loss of strength may be permanent. Surgical repair is based on the principle of reattaching the ruptured tendon to the bone. This procedure is typically performed as open surgery through a small incision, using special screws or fixation devices (such as an Endobutton) to secure the tendon.
Timely surgical intervention prevents both the cosmetic deformity and the functional loss. In the initial weeks, the tendon is protected with an arm sling and limited motion; a physical therapy process is initiated thereafter. Most patients achieve full strength and range of motion within 2–4 months.