Distal Bicep Tears

The biceps muscle is located in the front of the upper arm and is being attached to the shoulder and elbow by tendons. Biceps tendon tears at the elbow will not grow back to the bone and heal, making it hard to perform certain elbow movements. Notably, there will be difficulty in forearm supination, the movement of rotating the forearm from palm down to up. There may also be weakness in bending the elbow, although other arm muscles can help to complement this movement.


There are two types of tears:

  • Partial – tears damage the soft tissues but do not completely sever the tendon
  • Complete – tears detach the tendon completely from its attachment point
An image of arm with distal bicep tears

A “pop” at the elbow is often observed and pain may be severe at first but subside after a week or two. Other common symptoms of distal biceps tear include:

  • Swelling in the front of the elbow
  • Visible bruising 
  • Weakness in bending of the elbow
  • Weakness in turning the forearm, especially from palm down to up
  • A bulge in the upper part of the arm
  • A gap in the front of the elbow



Some common causes of distal biceps tear include:



Injuries to the biceps tendon usually occur when the elbow is forced straight against resistance, such as when lifting a heavy object or doing bicep curls in the gym. The stress on the biceps increases and the tendon tears away. 


Risk factors
Some risk factors that predispose to tendon degeneration and weakness, and increase the risk of tear include:

  • Men aged 30 and above
  • Smoking
  • Corticosteroid medications



Your orthopaedic specialist will start off with a physical examination to check your elbow by feeling the front of the elbow and looking for a gap in the tendon and testing your forearm rotation (supination) strength against resistance. To confirm the diagnosis, he or she may need to order imaging, such as an ultrasound or MRI scan. The scans will also help to tell between partial and complete tears, and how much the torn tendon has retracted into the arm.



Non-surgical treatments such as resting, activity modification (avoid heavy lifting activities) and nonsteroidal anti-inflammatory medications will help to relief the pain and swelling. Physical therapy is then recommended to maintain elbow range of motion, and to strengthen surrounding muscles to compensate for the torn biceps. However, it should be noted that the torn biceps tendon usually does not heal, and patients continue to have weakness in supination. Hence, this is more commonly an option for individuals who are older and less active. 


Surgery is usually required to repair the tendon and reattach it to bone, so as to restore biceps strength and function. This should preferably be done early (under 4 weeks) otherwise the biceps muscle/tendon may start to scar and retract, making the repair more difficult.


Every case is different; hence it is best to consult an orthopaedic specialist for an accurate diagnosis so that you can obtain the best treatment option that is most suitable for you. Reach out to us today if you suspect you are suffering from a distal biceps tear and let us help you enjoy a better quality of life.