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Distal biceps tendon injuries

The biceps muscle is the large muscle in the front of your arm that help to flex your elbow and rotate your forearm. The distal biceps tendon is the tendon that connects the biceps muscle to your forearm. This tendon is a common source of pain and injury. In most cases, distal biceps tendon injuries are related to overuse and tendonitis. At times, however; the tendon may tear either partially or completely. Biceps tendonitis/tears are most common in men aged 30 – 60, but may occur at any age and either sex.

Causes and risk factors

  • Repetitive lifting/forearm rotation
  • Overuse from work/sports
  • Traumatic injury from the elbow forcefully extending against weight


  • Pain, swelling, tenderness in the anterior forearm/elbow
  • Weakness/pain with elbow flexion and/or forearm rotation
  • In acute injuries, patient will often hear/feel a “pop” and develop significant bruising in along the elbow and forearm

Diagnosis and treatment

In many cases, the diagnosis is based on your history, symptoms, and exam. Plain radiographs (x-rays) may be obtained. If there is concern for a tear of the biceps, then an MRI of the elbow will often be ordered. Treatment depends on the extent of injury to the distal biceps tendon.  Tendonitis and partial tears are generally treated nonsurgically.

Nonsurgical treatment include rest, ice, nonsteroidal anti-inflammatory drugs (NSAIDS), and physical therapy. Activity modification is key, including avoiding aggravating activities. Most patients with tendonitis and/or partial tearing of the biceps can expect recovery and return to normal activity with non-surgical treatment. If conservative treatment options do not relieve your pain, your orthopedic surgeon may discuss surgery.

A complete tear of your distal biceps tendon can be treated either surgically or nonsurgically.  Your orthopedic surgeon should discuss options and relative advantages and disadvantages of both treatment options. With nonsurgical treatment, most experience some loss of strength but overall good function. Surgical treatment can maximize strength and function. It entails reinserting the torn tendon to its normal attachment on one of your forearm bones.