What it is
The biceps muscle bends the elbow and rotates the forearm so the palm faces up. At the elbow, its tendon attaches to the radius, one of the two forearm bones. A tear usually happens when the elbow is bent and a heavy load suddenly forces it straight.
Tears may be partial or complete. In a complete tear, the tendon pulls away from the bone and the muscle can retract up the arm. Smoking and anabolic steroid use have been associated with a higher risk.
Symptoms
- A sudden pop at the front of the elbow
- Pain and swelling at the front of the elbow
- Bruising at the elbow and forearm
- Weakness bending the elbow and turning the palm up, such as turning a doorknob or screwdriver
- A change in the contour of the upper arm as the muscle bunches up
Diagnosis
Diagnosis is based on the history and a focused examination, including the hook test, in which the examiner feels for the tendon at the front of the elbow. MRI or ultrasound confirms whether the tear is partial or complete and how far the tendon has retracted.
Complete tears are generally easiest to repair within the first few weeks after injury, so prompt evaluation matters.
Treatment options
Non-surgical
- May suit partial tears, or patients who accept some loss of strength
- Rest, then a guided physical therapy program
- Without repair, many people regain function for daily activities but may lose some strength and endurance, particularly when turning the palm up
Surgical
- Distal biceps tendon repair. Through one or two incisions, the tendon is reattached to the radius using secure fixation such as a cortical button, suture anchors or a screw.
- Repair is typically recommended for complete tears in active patients who want to restore strength.
- Older tears with significant retraction may require reconstruction with a tendon graft.
Recovery
- First weeks
The elbow is protected in a splint or brace while the repair begins to heal.
- Early rehab
Motion is restored gradually, following a protocol that protects the repair.
- Strengthening
Light strengthening typically begins a couple of months after surgery.
- Full recovery
Return to heavy lifting and full activity usually takes several months.
Timelines are typical ranges, not guarantees. Recovery depends on the specific injury, the procedure, your health and your rehabilitation, and your plan is individualized.
Questions patients ask
Is surgery urgent?
Not an emergency, but time-sensitive. Complete tears are generally easier to repair within the first few weeks, before the tendon retracts and scars.
Can I live without a repair?
Some people do, especially with partial tears or lower physical demands. The trade-off is usually some lasting loss of strength and endurance in bending the elbow and turning the palm up.
What are the risks of surgery?
All surgery carries risks, including infection, stiffness and irritation of nearby nerves. These are discussed in detail before any decision is made.
This page is general patient education and is not a substitute for an in-person evaluation.