Medical Disclaimer
This article is for informational purposes only and does not constitute medical advice. eBicep is not a medical provider and cannot diagnose, treat, or provide medical recommendations. Always consult a qualified healthcare professional for diagnosis and treatment of any injury or medical condition. eBicep and its authors assume no liability for any actions taken based on the information provided.
A distal bicep tendon tear—where the bicep detaches from the elbow—is one of the more serious bicep injuries. Unlike tendonitis or mild strains, this injury often requires surgical repair for optimal outcomes, especially in active individuals.
What Is a Distal Bicep Tendon Tear?
The biceps muscle attaches to the radius bone in your forearm via the distal biceps tendon. A tear occurs when this tendon partially or completely detaches from the bone.
This injury most commonly occurs in men aged 30-60, particularly those who lift weights or perform heavy manual labor. It typically happens during a sudden, forceful contraction—often when catching a heavy falling object or during an unexpected eccentric load.
Signs and Symptoms
At the time of injury:
• Sudden, sharp pain at the front of the elbow
• Audible or palpable "pop"
• Immediate weakness
In the hours/days following:
• Swelling and bruising at the elbow and forearm
• A gap or soft spot where the tendon should attach
• "Popeye" deformity—bicep muscle bunches up toward the shoulder
• Weakness in elbow flexion (curling motion)
• Significant weakness in forearm supination (turning palm up)
The supination weakness is particularly notable—the biceps is a primary supinator, and with a complete tear, supination strength can decrease by 40% or more.
Partial vs. Complete Tears
Partial tears: Some tendon fibers remain attached. May cause pain and some weakness but the "Popeye" deformity is usually absent. Some partial tears can be treated conservatively; others progress to complete tears.
Complete tears: The tendon is fully detached from bone. This is the more common presentation and typically requires surgery for active individuals.
Treatment Options
Surgical repair (recommended for most):
Surgery reattaches the tendon to the bone using various techniques (suture anchors, button fixation, etc.). Best outcomes occur when surgery is performed within 2-3 weeks of injury, though delayed repairs are possible.
Surgery is generally recommended for:
• Active individuals who want full strength return
• People who need forearm rotation strength for work or activities
• Athletes and weightlifters
• Complete tears
Non-surgical treatment:
Some patients may opt against surgery, particularly:
• Older, sedentary individuals
• Those with significant medical risks from surgery
• Partial tears that remain stable
Non-surgical treatment results in permanent loss of supination strength (30-40%) and some loss of elbow flexion strength (10-20%). The "Popeye" deformity will remain.
Surgical Recovery Timeline
Week 1-2:
• Arm in splint or brace
• Focus on rest and wound healing
• Gentle finger and wrist movement allowed
Week 2-6:
• Begin gentle range of motion exercises
• Physical therapy typically starts
• Brace may be weaned
• No lifting or resistance
Week 6-12:
• Progressive strengthening begins
• Light resistance exercises
• Continued physical therapy
Month 3-6:
• Progressive return to normal activities
• Gradual return to lifting (typically around 4-6 months)
• Full recovery may take 6-12 months
Returning to Lifting After Surgery
This must be discussed with your surgeon and physical therapist, but general principles:
• No lifting for approximately 3 months
• Light lifting (under 15-20 lbs) begins around 3-4 months
• Progressive loading over months 4-6
• Full return to heavy lifting typically 6-9 months post-surgery
• Some surgeons recommend permanent avoidance of maximum single-rep efforts
Can It Happen Again?
Re-rupture after surgical repair is uncommon (less than 5% in most studies) when rehab is followed properly. However:
• Returning too quickly increases re-rupture risk
• The opposite arm's tendon may be at elevated risk
• Addressing contributing factors (form, realistic loading) is important
The Bottom Line
Distal bicep tendon tears are significant injuries that usually require surgical repair for optimal outcomes in active individuals. If you suspect this injury—especially if you heard a pop, have significant bruising, or notice a change in your bicep shape—seek medical evaluation promptly.
Recovery is measured in months, not weeks. Patience with rehabilitation is essential for a good long-term outcome.