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Distal Bicep Tendonitis Specialist
Dr Poh Seng Yew (傅圣耀)
MBBS
MRCSEd
MMED (Ortho)
FRCSEd
What are Distal Bicep Tears?
Distal bicep tears occur when the tendon attaching the biceps muscle to the elbow is damaged. The biceps muscle, located in the front of the upper arm, is connected to the shoulder and elbow by tendons, which are strong fibrous tissues. When this gets torn, it is known as a distal bicep tear.
Once torn, the biceps tendon at the elbow will not naturally reattach to the bone, impacting certain elbow movements, such as forearm supination (the action of rotating the forearm to turn the palm upwards).
Types of Distal Bicep Tears
Distal bicep tears can be categorised into two main types:
Partial Tears
These involve damage to the soft tissues of the tendon but do not completely sever it from the bone. Despite the partial nature of these tears, they can still impact the function of the biceps muscle and the forearm.
Complete Tears
This type represents a full detachment of the tendon from its attachment point at the bone. In complete tears, the entire muscle is detached, often recoiling towards the shoulder. This results in more pronounced functional deficits, especially in forearm rotation and elbow flexion.
Causes of Distal Bicep Tears
Distal bicep tears are typically caused by a combination of factors:
- Injury
The most common cause is a sudden injury, often occurring when the elbow is forced to straighten against resistance. This often occurs during activities such as lifting heavy objects or engaging in certain gym exercises, including bicep curls. The tendon may tear under excessive stress. - Repetitive Movements and Overuse
Consistent or intense overuse of the bicep tendon can lead to fraying and eventual tearing. This is particularly relevant in activities involving repetitive arm motions or heavy lifting. - Weakened Physical Condition
Individuals with weaker muscles or tendons, whether due to lack of exercise, previous injuries, or certain health conditions, may be at higher risk of distal bicep tears. Certain lifestyle factors, including smoking, can also weaken the body and increase the likelihood of developing the condition. - Age-Related Degeneration
The likelihood of experiencing a distal bicep tear increases with age. This is because tendons lose elasticity and strength over time, making them more prone to injury.
Symptoms and Signs
The symptoms and signs of a distal bicep tear include:
- Hearing or Feeling a Popping Sensation: Many individuals report hearing or feeling a “pop” in the elbow area at the time of injury.
- Pain: Individuals may initially experience intense pain in the elbow. This discomfort tends to diminish within one to two weeks.
- Swelling and Bruising: Swelling at the front of the elbow, accompanied by visible bruising in the elbow and forearm.
- Weakness: Notable weakness in bending the elbow and in twisting the forearm, particularly from a palm-down to palm-up position.
- Muscle Deformation: A bulge in the upper part of the arm caused by the recoiled, shortened biceps muscle, and a gap in the front of the elbow where the tendon was attached.
Diagnosis
Diagnosis of distal bicep tears involves several steps:
- Medical History and Symptom Review: The elbow specialist begins by reviewing the patient’s medical history and symptoms, focusing on the onset, nature, and progression of the discomfort and functional limitations experienced.
- Physical Examination: The elbow specialist will check the elbow by feeling for a gap in the tendon and testing the forearm rotation (supination) strength against resistance.
- Imaging Tests: An ultrasound can be used to measure the extent of recoil of a torn tendon and an MRI can help provide detailed images of soft tissues to differentiate between partial and complete tears. X-rays may also be employed to rule out other causes of elbow pain.
Non-Surgical Treatment Options
There are several non-surgical management strategies for distal bicep tears. While they can help alleviate pain and maintain arm function, they do not facilitate the healing of the torn biceps tendon and some level of supination weakness may persist. These treatment options are typically considered for individuals who are older, less active or have medical conditions that increase the risks associated with surgery.
Rest and Activity Modification |
For less severe cases, the elbow specialist may initially suggest avoiding activities that exacerbate the injury, particularly those involving heavy lifting or intensive use of the arm. |
Medications |
Nonsteroidal anti-inflammatory medications (NSAIDs) like ibuprofen and naproxen help reduce pain and swelling. |
Physical Therapy |
This helps maintain the range of motion and strengthen the surrounding muscles in the elbow. It can compensate for the weakness caused by the torn biceps tendon. |
Surgical Treatment Options
Surgical intervention can help restore full strength and function to the arm, especially in cases of complete tears.
Distal Biceps Tendon Repair
This surgery aims to repair and reattach the torn tendon back to the bone. In this procedure, the tendon can be reattached using suture anchors, which are small metal implants, or through bone tunnels, where stitches are passed through holes drilled in the radius bone.
Ideally, surgery should be performed within 4 weeks after injury. Delaying surgery may lead to scarring and shortening of the muscle, complicating the repair process.
Prevention Strategies
Preventive measures for distal bicep tears focus on minimising the risk of tendon injuries and supporting tendon health.
- Avoid Smoking to Improve Blood Circulation - Smoking can impair blood flow, which may prevent the tendon from healing effectively. Abstaining from smoking can reduce this risk.
- Use Proper Techniques to Reduce Strain - Use proper techniques and controlled movements when engaging in weightlifting or physical activities involving the arms. This can help prevent undue stress on the biceps tendon.
- Regular Stretching and Conditioning - This can prepare the tendons and their bone insertions for the demands of athletic activities, reducing the risk of traumatic injury.
- Enhancing Core and Shoulder Strength - Strengthening the core and shoulder muscles can support the health and resilience of the biceps tendon.
Dr Poh Seng Yew (傅圣耀)
MBBS
MRCSEd
MMED (Ortho)
FRCSEd
With over 20 years of experience, Dr Poh Seng Yew (傅圣耀) is an orthopaedic surgeon specialising in hip, knee, shoulder and elbow surgery, sports medicine, and trauma surgery.
- Former Director of Sports Service, Department of Orthopaedic Surgery, Singapore General Hospital
- Clinical Hip and Sports Medicine Fellow, Orthopädische Chirurgie München (OCM), Germany
- Fellow, Royal College of Surgeons of Edinburgh, FRCSEd (Orthopaedic Surgery)
- Master of Medicine (Orthopaedic Surgery), National University of Singapore
- Member, Royal College of Surgeons of Edinburgh (MRCSEd)
- Bachelor of Medicine, Bachelor of Surgery (MBBS), National University of Singapore
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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-62/63
Singapore 329563
Weekdays: 9.00am – 5.00pm
Saturdays: 9.00am – 1.00pm
Sundays and Public Holidays: Closed
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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-62/63
Singapore 329563
Frequently Asked Questions (FAQ)
Can You Still Move Your Arm with a Distal Bicep Tear?
While arm movement is possible with a distal bicep tear, the range and strength of motion may be limited. Consult an elbow specialist for a personalised treatment plan to manage the condition while maintaining arm function.
What Happens If a Distal Bicep Tear Is Left Untreated?
Leaving a distal bicep tear untreated can lead to persistent weakness, especially in forearm twisting motions. You may consult our elbow specialist for a tailored treatment plan to prevent long-term functional limitations.
How Long Does It Take for a Distal Bicep Tendon to Heal?
The healing time for a distal bicep tendon varies depending on the severity of the tear and the chosen treatment method. Surgical repair generally offers a more predictable and quicker recovery timeline.
What Exercises Can Help Aid Recovery from a Distal Bicep Tear?
Specific exercises can aid in the recovery from a distal bicep tear. These exercises focus on strengthening surrounding muscles and maintaining range of motion. Our elbow specialist can guide you through appropriate and safe exercise routines.
Can I Return to Sports or Weightlifting After a Distal Bicep Tear?
With appropriate treatment and rehabilitation, returning to sports or weightlifting is possible after a distal bicep tear. The timeline and extent of return depend on the injury’s severity and the success of the treatment.