Distal Biceps Rupture

When this tendon ruptures it can be partial or complete. A partial rupture is a tear of the tendon while a complete rupture is complete detachment of the tendon from the bone. Complete ruptures cause the muscle to retract upward toward the shoulder, sometimes creating a visible “Popeye” bulge. This injury typically affects the dominant arm and most often occurs in active individuals or those who perform heavy lifting. Although it can happen suddenly, it often results from wear and weakening of the tendon over time.

The onset of symptoms is usually immediate. Patients describe:

• A sharp pain at the front of the elbow accompanied by a popping sound or sensation.
• Swelling and bruising develop quickly and may extend down the forearm.
• Many individuals notice a change in the shape of the upper arm as the biceps muscle pulls upward.
• Weakness when bending the elbow or turning the palm upward (supination) is common.
• Daily activities such as lifting, carrying, or twisting objects become difficult. In partial tears, the symptoms may be milder, with ongoing pain and weakness rather than complete loss of strength.

A distal biceps rupture typically happens when a person forcefully extends the elbow against resistance while it is bent. Common causes include trying to lift or catch a heavy object or performing strenuous pulling movements during sports or work. Over time, repetitive stress can cause small microtears that weaken the tendon, making it prone to rupture during sudden strain. Age-related changes also reduce the tendon’s elasticity and blood supply. Smoking, steroid use, and certain medical conditions such as diabetes can further compromise tendon health, increasing the likelihood of injury. Though less common, a direct blow to the front of the elbow can also cause a rupture.

Middle-aged men who perform manual labor or strength-based activities face the greatest risk. Athletes who frequently use their arms for heavy lifting or repetitive overhead motions are also vulnerable. Lifestyle factors such as smoking and the use of corticosteroid or anabolic steroid medications contribute to tendon weakening. Individuals with metabolic or systemic conditions that affect tissue healing, such as kidney disease or diabetes, are more susceptible. Preventive measures, including proper lifting technique and maintaining overall tendon health, may help reduce the risk.

Diagnosis begins with a detailed medical history and physical examination. Dr. Collon will ask how the injury occurred, the severity of symptoms, and any changes in strength or arm appearance. During the exam, the front of the elbow is inspected for bruising, swelling, and deformity. The hook test is a key diagnostic maneuver—if the tendon cannot be felt or “hooked” by the examiner’s finger, a complete rupture is likely. Range of motion and muscle strength are also evaluated.

Imaging tests are often used to confirm the diagnosis. Ultrasound can quickly detect whether the tendon is intact or torn, while MRI provides a detailed image of the soft tissues, helping determine if the rupture is partial or complete. Accurate and early diagnosis is essential because prompt treatment leads to better recovery outcomes.