Distal Biceps Rupture: Causes and Treatment

A distal biceps rupture occurs when the tendon attaching the biceps muscle to the radial tuberosity in the forearm tears. This is less common than proximal biceps tears but can significantly impact arm strength and function.

Causes of Distal Biceps Rupture

1. Trauma or Sudden Overload:
   • Sudden, forceful contraction of the biceps against resistance (e.g., lifting a heavy object).
   • Common during activities requiring abrupt pulling or lifting.
2. Degeneration of the Tendon:
   • Age-related wear and tear can weaken the tendon, making it prone to rupture.
   • Most cases occur in men over 40.
3. Overuse or Repetitive Strain:
   • Repeated heavy lifting or arm-intensive work can lead to microtrauma and eventual failure of the tendon.
4. Smoking or Poor Circulation:
   • Smoking impairs tendon health and healing due to reduced oxygen supply.
5. Use of Corticosteroids or Anabolic Steroids:
   • These drugs may weaken tendons over time.
6. Chronic Tendinopathy:
   • Pre-existing inflammation or degeneration in the distal biceps tendon increases rupture risk.

Symptoms of Distal Biceps Rupture

• Sudden, Sharp Pain: Felt in the front of the elbow at the time of injury.
• “Pop” Sensation: Audible snapping or popping sound during the rupture.
• Weakness: Difficulty with arm flexion (bending the elbow) and forearm supination (rotating the palm upward).
• Swelling and Bruising: Visible bruising near the elbow.
• Popeye Deformity: Biceps muscle retracts toward the shoulder, creating a bulge.

Treatment Options for Distal Biceps Rupture

Non-Surgical Treatments (For Partial Tears or Low-Demand Patients)

1. Rest and Activity Modification:
   • Avoid activities that stress the biceps.
2. Pain Management:
   • NSAIDs (e.g., ibuprofen) to reduce pain and swelling.
3. Physical Therapy:
   • Focus on compensatory muscle strengthening to maintain function in mild cases.
   • Not recommended for active individuals with a complete tear.

Surgical Treatment (Gold Standard for Complete Ruptures)

1. Tendon Reattachment:
   • The torn tendon is surgically reattached to the radial tuberosity.
   • Performed through a single or double incision technique.
2. Timing of Surgery:
   • Best results occur within 2–3 weeks post-injury. Delay may lead to tendon retraction and complicate surgery.
3. Recovery:
   • Immobilization: Arm is immobilized in a sling or brace for a few weeks.
   • Rehabilitation: Gradual strengthening and range-of-motion exercises. Full recovery can take 4–6 months.

Complications of Untreated Ruptures

• Loss of 30–50% of forearm supination strength.
• Loss of 30–40% of elbow flexion strength.
• Chronic pain or deformity.

Prevention Tips for Distal Biceps Rupture

1. Avoid Overloading the Biceps: Use proper form when lifting heavy objects.
2. Warm-Up and Stretch: Prepare muscles and tendons for physical activity.
3. Strength Training: Strengthen surrounding muscles to reduce strain on the biceps.
4. Avoid Smoking: Improve tendon health and healing capacity.
5. Address Tendinopathy Early: Seek treatment for chronic biceps or elbow pain to prevent progression.