The biceps muscle is located in front of your upper arm. It helps in bending your elbow, rotational movements of your forearm and in maintaining stability in the shoulder joint. The biceps muscle has two tendons, one of which attaches it to the bone in the shoulder and the other attaches at the elbow. The biceps tendon at the elbow is called the distal biceps tendon. A tear in this tendon will make it difficult for you to move your arm from the palm down to palm up position. Once the distal biceps tendon is torn, it cannot regrow back to the bone and heal by itself. Permanent weakness during rotatory movements of the forearm may occur, e.g., such as using a screwdriver, if the tendon is not repaired surgically.

Biceps tendon tear can be complete or partial. In partial biceps tendon tear, the tendon does not tear completely but is often painful. A Complete tendon tear means it ruptures completely off the radius bone.


Distal biceps tendon ruptures most often result from a sudden injury or lifting a heavy object. Additional risk factors, such as advancing age, smoking and use of corticosteroid medications, can also result in increased muscle and tendon weakness, which can lead to the tendon rupture.

Signs and symptoms

The most common symptom is a sudden, severe pain in the upper arm or at the elbow.  You may feel a “pop” at the elbow when the tendon tears. Other symptoms include swelling, visible bruising, weakness in the elbow, trouble turning your arm from a palm down to a palm up position, and a gap in the front of the elbow, caused by the absence of the tendon.  A bulge may also appear in your arm caused by the recoiled, shortened biceps muscle.


Distal biceps tendon rupture is usually diagnosed based on your symptoms, medical history, and physical examination. During the physical examination, Dr Bala will look for a gap in the tendon by palpating the front part of your elbow. He will also look for movement of the elbow on squeezing the muscle belly. Dr Bala will diagnose a partial tear by asking you to bend your arm and tighten the biceps muscle, and identify weakness and pain if there is a partial tear. Using an Ultrasound or MRI scan (a special view called the FABS view), Dr Bala can determine whether the tear is partial or complete

Non-operative treatment 

Tendinitis of the distal biceps tendon without tears or partial tears of the distal biceps can be managed conservatively with rest, painkillers and graded physiotherapy to strengthen the tendon. In rare instances Dr Bala may opt to use cells from your own blood that are rich in undifferentiated cells. This preparation is called Platelet Rich Plasma or PRP. This injection may aid healing of minor tears of the distal biceps tendon.


During distal biceps repair, Dr Bala makes a small incision over the upper forearm, where the biceps muscle attaches to the radius bone. The torn biceps tendon is brought up through the incision. Rarely a second incision will have to be made in the lower arm in long standing cases where the tendon will have shortened. The radius bone is then prepared for tendon reattachment and to promote healing. The sutures are passed through the tendon in a particular interlocking manner so as to ensure a strong tendon repair. Dr Bala prefers to fix the tendon to the radius using a device called a biceps button and uses a single incision for this procedure. He uses a technique to repair the tendon back to its anatomic footprint (anatomic distal biceps repair).

If the tear has been long standing an artificial tendon will have to be harvested form the patient’s own body (autograft) or another graft from a compatible donor (allograft) will be used to reconstruct the distal biceps tendon.

As this procedure is performed near important nerves that supply the wrist and hand Dr Bala will explain in more detail the risks involved with this surgery and what precautions he takes to prevent them from happening. Dr Bala takes special precautions including wearing magnifying loupes while performing this surgery to protect important structures near the elbow to prevent complications. In the event you may have a tattoo on the elbow or forearm Dr Bala is well versed in suturing tattoos back accurately with absorbable sutures. 2 weeks after the surgery gentle exercises are instituted to regain range of movement and strength to the elbow.

Dr Bala specializes in dealing with complications of distal biceps repair or revisions of failed prior surgery.