Distal Biceps Tendon Tear Treatment in Adelaide
Dr Arthur Turow, Elbow SurgeonA distal biceps tendon tear involves injury to the attachment at the elbow. It can cause bruising, pain & weakness when turning your palm upwards. Dr Arthur Turow assesses and treats distal biceps injuries in Adelaide, including partial tears & complete ruptures. Treatment depends on your injury, the demands of your work and your sporting ambitions.
Illustration showing a distal biceps tear. The biceps inserts at the radius at the front of your elbow.
With a distal biceps tear, the tendon connecting your biceps to the forearm at the elbow is damaged
A sudden pop, bruising and biceps contour changes are common signs
You should arrange prompt assessment after a new injury, even if the pain starts to settle
Partial tears can improve without surgery. Complete tears can leave lasting weakness
Distal biceps repair means reattaching the torn tendon back to its bone
Recovery takes several months. Strengthening starts from three months. Return to sport is often around six months
What is a distal biceps tendon tear?
The distal biceps tendon connects the biceps muscle in your upper arm to the radius, one of the bones in your forearm. The biceps helps bend your elbow and is particularly important for turning your palm upwards against resistance, a movement called supination.
A tear often happens when your elbow moves into extension from a flexed position while a load is being applied to your elbow. Some examples of this are weightlifting, wrestling, an unexpected heavy object falling on your arm or during heavy manual labour.
There are two main tear types:
Partial tear: Some tendon fibres tear, while the tendon remains attached to the bone.
Complete rupture: The tendon has completely detached. The muscle frequently pulls upwards towards the shoulder, changing the contour of your biceps.
A distal biceps tear happens at the elbow. This is different from a proximal biceps tendon tear; here, the biceps tears at the shoulder joint & treatment is different to a distal biceps tear.
The biceps tendon attaches to one of the forearm bones, called the radius. It helps you bend your elbow and turn your palm upwards
What are the symptoms of a distal biceps tear?
Complete distal biceps tendon ruptures usually have these symptoms:
- Sudden pop or tearing sensation at the front of your elbow
- Pain, swelling and bruising around the elbow or forearm
- Weakness when supinating your forearm
- Change in the shape of your biceps muscle or a gap near the elbow
Partial tears can be less obvious, causing pain during lifting or twisting without a clear change in muscle shape.
After a complete rupture, pain may settle even though the tendon remains detached. Being able to move your elbow does not rule out a biceps rupture. A new injury with bruising or weakness should be assessed promptly.
Clinical photo of a distal biceps tear showing bruising, swelling and a change in the biceps muscle (arrow)
How is a distal biceps tendon tear diagnosed?
Dr Turow will ask how and when your injury happened. He will examine your elbow and biceps. Assessment includes checking tendon continuity and your strength supinating your forearm.
The most useful clinical test to identify a complete rupture is the hook test. Ultrasound is beneficial to confirm a tear and location of the tendon stump. MRI is not normally needed in acute injuries, but may be used when a partial tear is suspected or if you have injured your biceps a while ago. X-rays can exclude other injuries, but do not show the tendon itself..
Clinical photo showing the hook test to assess the biceps at the elbow. It is done with your elbow bent to 90 degrees and the examiner attempts to hook their index finger underneath the tendon.
How soon should a torn distal biceps tendon be assessed?
Arrange an assessment promptly after a suspected rupture. When surgery is appropriate, repair is often easier during the first few weeks, before the tendon becomes more scarred or retracted.
There is no single deadline after which treatment becomes impossible. Older tears may still be suitable for direct repair. In some cases, a tendon graft is needed if the original tendon cannot reach its attachment safely.
Research on delayed repairs shows that selected patients can still achieve useful function and satisfactory outcomes. An older injury is therefore still worth assessing.
Treatment for a distal biceps tendon tear
Treatment depends on: whether your tear is partial or complete; how long ago you have injured yourself and what you need your arm to do for daily activities and sports.
Treatment without surgery
Some partial tears can be treated with no surgery: activity modification, pain relief and guided physio. Physiotherapy aims to improve your function while gradually rebuilding your arm’s strength and tolerance to activity/ loading.
Surgery for partial tears may be needed if you have continued pain and weakness that interferes with your work, sports and daily activities. The right treatment for your elbow depends on your individual needs and your response to non-surgical treatment.
Non-surgical treatment for complete ruptures is an option when you are unlikely to be affected by the rupture or when the risks of surgery outweigh its likely benefits. A completely detached biceps tendon left untreated can leave you with weakness and fatigue when twisting and lifting your forearm.
Distal biceps tendon repair
Repair is frequently recommended for patients with a complete rupture who want to restore strength for manual work, lifting or sport.
The operation reattaches the tendon back to its attachment at the radius. A small titanium button holds the tendon in place while it heals back to the bone.
Studies generally report better recovery of strength after surgical repair of complete distal biceps ruptures than after non-surgical treatment. However, the decision to operate still needs consider risks of surgery and the involved rehab.
What are the risks of surgery?
Possible complications include infection, elbow stiffness, numbness around the forearm, nerve injury causing weakness, abnormal bone formation at the attachment of the elbow and failure of the repair. Dr Turow will discuss the risks relevant to your injury with you.
Recovery after distal biceps tendon repair
Repair of a biceps tendon tear involves re-attaching the tendon back to its original footprint using a specialised titanium button.
The biceps is repaired back to bone using specialised sutures and a titanium button. While the re-attachment is strong, the repair relies on your body to heal and this takes time. You will be able to start early, gentle range of motion from two weeks. Your physio will guide you through the rehab stages. An approximate timeline is outlined below:
Stage 1: Protecting your re-attachment (0 to 6 Weeks)
- First 2 weeks: wound care, swelling and pain management
- In the first six weeks the re-attachment needs to be protected
- You can start on some early range of motion from two weeks
- You will need to wear a sling during most of this time
Stage 2: Increase Range of Motion (6 to 12 Weeks)
- The sling is gradually weaned
- Focus on elbow & forearm movement
- Continue avoiding lifting and resistance
Stage 3: Strengthening (3-6 Months)
- In the next three months you focus on strengthening
- Resistance training is gradually increased as your endurance increases
Returning to work
A systematic review of 1,270 patients reported that 89% returned to work without modified duties. The average return was about 14 weeks.
This average included different occupations. Desk work or modified duties may be possible earlier, while heavy manual work can require longer. Your return to work will depend on how much lifting, pulling and repetitive tasks you need to do during your job.
Returning to gym training & sport
A recent 2025 systematic review reported that 91.5% of patients returned to sport after distal biceps repair, with an average return time of about 6 months.
Returning to sport does not necessarily mean returning immediately to previous lifting at a competitive level. Heavy curls, pulling exercises & contact sport need healing, movement and gradual strength building.
Why choose Dr Arthur Turow?
Dr Arthur Turow is an Australian-trained orthopaedic surgeon whose practice focuses on shoulder and upper limb conditions.
He assessed elbow injuries and discusses treatment in context of your work, sporting and rehab goals. Your consultation provides an opportunity to understand your injury, consider treatment options and plan your rehab.
Consultations are available in Adelaide CBD and at regional locations across South Australia, including Yorke Peninsula, Gawler and Mt Barker.
To arrange an assessment, book an appointment or call (08) 8236 4179.
Frequently Asked Questions
Can I still bend my elbow if my biceps tendon is torn?
Yes. Other muscles also bend your elbow, so you may still be able to bend and straighten it after a complete distal biceps rupture. Weakness when turning your palm upwards (supination) against resistance is more noticeable. Preserved elbow movement does not rule out a tear.
Can a distal biceps tendon tear heal without surgery?
Sometimes. Partial tears can heal without surgery. A completely torn biceps tendon does not reattach itself back to its original position without surgery. Some patients manage well with the remaining function, while others find the weakness limits their work, gym or sports.
Is it too late to repair an older distal biceps rupture?
Not necessarily. A repair depends on your tendon retraction, scarring and the tendon quality. Some older tears can be repaired directly; others require a reconstruction using a tendon graft. Older distal biceps tears frequently need further imaging, e.g. MRI.
When can I start biceps curls after surgery?
You need clearance by your surgeon and physio before re-staring resistance work. A gradual recovery of strength and exercises is safest. Heavy curls require a later stage of recovery than gentle movement or low resistance exercises.
Further Reading
Information for patients:
- AAOS OrthoInfo: Biceps Tendon Tear at the Elbow. An illustrated explanation of symptoms, diagnosis and treatment.
Interested in more scientific information about biceps tendon tears and rehab?
For Patients
If you have injured your elbow, it is important to get your elbow evaluated and to perform appropriate diagnostic tests. Dr. Arthur Turow will provide expert assessment of your injury and recommend a tailored treatment for your specific injury to help you achieve the best outcome.