Distal Biceps Rupture

Bulbous mass forms at bicep region, swelling and bruising at elbow

What is distal biceps rupture?

Distal bicep tendons are muscles that are attached to the elbow, specifically the radial tuberosity. A rupture of this muscle indicates an occurrence of a tear of the ligament from the bone. It is notably a rare form of injury (3%) in comparison to its counterpart; proximal bicep tendon rupture. A distal bicep rupture limits one’s movement, specifically the motion of supination which is the rotation of the forearm from palm up to palm down. 

There are two types of tears that can occur:

  • Partial tear: damage occurs at the soft tissue, however, tendons are not completely severed. 
  • Complete tears: distal bicep tendons have completely detached from the elbow joint. 
distal bicep rupture
A rupture of the distal biceps can occur either partially or completely.

What causes distal biceps rupture?

The main and most frequent cause of distal bicep rupture is:

  • Injury: mostly occurs when carrying heavy weights. Patients have reported sudden straightening of the elbow when lifting which leads to tendons snapping. The elbows straighten involuntarily as a shock response to the sudden weight introduced when lifting. 
improper lifting
Improper versus proper lifting of heavy objects that could lead to distal bicep rupture.

What are the symptoms of distal biceps rupture?

Distal biceps rupture has one of the more palpable symptoms which includes:

  • Popping sound when tendons rupture (only if it is a complete tear)
  • Immediate swelling and bruising at the elbow which could spread to the forearm
  • “Popeye deformity” also known as bulbous mass forms at the bicep region
  • Weakness when bending the elbow, lifting the shoulder, or during supination
If you notice any of the symptoms, make an appointment with an orthopaedic specialist to get an accurate diagnosis and treatment.

Dr Puah KL is our Senior Consultant Orthopaedic Surgeon at Artisan Sports & Orthopaedic Surgery. He used to serve the sports service of Singapore General Hospital - the highest volume trauma centre for orthopaedics in Singapore.

Is distal biceps rupture painful?

Yes. Distal bicep rupture can be excruciating. However, when a complete tear occurs, pain subsides fairly quickly whereas, in partial tears, pain tends to persist.

Regardless of the type of tear and persistence of pain, distal bicep rupture is hard to miss as weakness of the arm is quick to follow causing immediate limitation of mobility.

Who is at risk of distal biceps rupture in Singapore?

A distal bicep rupture is a rare form of injury, however, some of the identified risk factors include:

  • Gender: men are more likely to suffer from this injury and it may be related to the types of activity conducted such as weightlifting and participating in labour-intensive jobs. 
  • Age: this injury most commonly occurs among people between the age of 30 to 55. 
  • Smokers: nicotine is attributed to lowered elasticity of the tendons.
  • Use of steroidal drugs: studies have shown that extensive use of steroids to increase body mass leads to muscle and tendon weakness. 
Distal biceps ruptures have been linked to the use of steroids.

How is distal biceps rupture diagnosed?

Often, the manifestation of “Popeye’s deformity” is sufficient to provide a distal bicep rupture. 

Nevertheless, one or more of these examinations will be carried out to gauge the extent of damage acquired:

  • Physical examination and medical history: inform your doctor of the potential activities that may have led to an injury such as trauma, exercise, or sports. Physically the area of injury will be examined and several motion tests will be conducted to review the injury. 
  • Ultrasound or magnetic resonance imaging (MRI): MRI or dynamic ultrasonography would be required to review the bulbous mass and to identify the extent of the tendon tear. 
  • X-rays: an x-ray would be ordered if your orthopaedist suspects an incidence of fracture

What are the treatment options for distal biceps rupture in Singapore?

Non-surgical options are occasionally considered depending on the severity of the condition. 

These include:

  • Rest: you would be advised to observe complete rest to relieve pain and reduce swelling
  • Elbow sling: would be provided to reduce all forms of mobility of the impacted region. 
  • Medication: oral drugs (NSAIDs) and painkillers are commonly prescribed as the first course of treatment and to manage inflammation and pain. 
  • Physiotherapy: upon discontinuation of the use of an elbow brace/splint/sling, an active range of motion exercise would be administered via physiotherapy to regain mobility. 
  • Surgery: if the condition persists, a distal biceps reconstruction would be performed within 2-3 weeks of injury as non-surgery past this timeframe will risk non-recovery of arm function. Delay in surgical treatment also increases complications and reduces healing capabilities. 
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