The tendon that connects your biceps muscle into your forearm inserts on a small prominence in upper part of your radius bone called the biceps tuberosity. Rupture of the distal biceps tendon is relatively common. The classic mechanism of injury is a sudden lengthening of the contracting muscle (eccentric force). This might be when catching a very heavy load or when doing heavy weights (e.g. biceps negative) in the gym. This rupture normally occurs at, or very close to it’s insertion into the radius bone, but occasionally the damage is near the muscle-tendon junction. The typical patient is an active male (rupture is very rare in ladies) in his 30s-50s. Many patients will have done lots of weight training in the past, or have a heavy manual job. The risk of rupture is increased in those who have used growth factor supplements to increase muscle gain (e.g. Deca or anabolic steroids) because these drugs allow the muscle to grow too quickly for the tendon to adapt.
Most patients feel a sudden pop or ripping sensation at the front of their elbow with immediate pain in their lower arm and upper forearm. It normally happens after lifting or dropping a heavy load. This pain is followed by swelling and bruising in the elbow crease and into the forearm. Patients report weakness in bending their elbow and in twisting their forearm. They often also notice an altered contour of the biceps muscle – the muscle belly will likely sit higher up in the arm (compare to opposite side). Also, patients sometimes notice that the biceps muscle belly will not move when they twist their forearm.
Photographs of the left and right arms of a 40 yr old man showing a retracted, chronic left distal biceps rupture
Yes, it is possible to rip off only part of the tendon. The injury mechanism is normally the same, but the deformity will not be present if there is only a partial rupture. If the symptoms remain severe, an MRI is useful in this situation to quantify the damage and plan management.
Most active working-aged patients will elect to have distal biceps repair surgery to restore optimum function if their tendon is fully torn, but it is not mandatory for every ruptured tendon to be repaired. As the biceps is a strong clockwise rotator of the right arm, right-handed patients with a right-sided injury tend to suffer more disability (e.g screwdrivers etc. are designed to be used clockwise in the right hand). If you have injured your left biceps and have a desk job you may do fine without surgery.
In a study assessing patients with distal biceps ruptures, those with un-repaired distal biceps ruptures had lost 30% of their flexion power and 45% of forearm outwards twisting (supination) torque. They also experienced cramping and loss of endurance in the injured arm. After repair approximately 95% of normal power in both movements is typically restored. If you have injured your non-dominant arm and have a low-demand job and lifestyle, you may manage well without surgery. If however, you have injured your dominant arm and engage in an active lifestyle, it is likely you will do better with surgery.
If you have a partial rupture of your tendon it is worth holding off with surgery to see how you recover as your tendon may heal. If you struggle to recover at three months, your tendon can still normally be repaired at that point
Mr Granville-Chapman was very polite and his examination and explanation of my symptoms and expected treatment was thorough
I found Mr Granville-Chapman to be very knowledgeable and professional. He put me very much at ease and explained all the options that I have thoroughly. He also told me to look for further information on the condition and procedures that I needed on his website, which gave lots of information and detail. It was also easy to understand for those without a medical background. I would highly recommend his services to anyone that has shoulder problems and requires a solution.
I attended for a repair of my right bicep tendon. After a thorough examination, Mr Granville-Chapman arranged an operation to be undertaken within 2 days which was extremely quick; he explained his reasoning which was both thorough and reassuring, explaining both the options of undergoing surgery and deciding to undertake conservative management.On the day of the surgery Mr Granville-Chapman was again very reassuring as although this is minor surgery I was still somewhat apprehensive. He came to fully explain the procedure and afterI woke up was quick to check on how I was doing.Overall I am very happy with the careMr Granville-Chapman
I have been very pleased with my treatment so far. Mr Granville-Chapman combines brisk efficiency with a pleasant, sympathetic manner. My operation, however, is still to come ...
From the initial consultation, through surgery on a fractured wrist, and now post-operative follow up, it has been a very positive and reassuring experience with Mr Granville-Chapman. I would have no hesitation in recommending him to someone else.
A first class clinician. A skilled surgeon with an excellent bedside manner.
A very pleasant Consultant who knows exactly how to make pain go away.
Mr Granville - Chapman has an excellent bedside manner. He engaged with my 12 year old son at an appropriate level and took the time to ensure that he understood the procedure and answer all his questions. He is thoroughly professional and I would not hesitate to recommend him.
I have been very pleased with the attention I have received. Mr. Granville-Chapman has reassured me that my symptoms are normal. It is very easy to make appointments that suit me.
Mr Granville chapman I found be caring informative and professional I would recommend him to all if you have a problem don't hesitate to contact him you won't be disappointed.
I recently broke my right clavicle in a mountain bike accident and it was repaired by Mr Granville-Chapman by adding a plate on top of the bone. Having just finished the last post-op consultation, I can confirm that I have been very happy with the process all along. In particular, Jeremy took time to explain in detail why a plate was needed, what the procedure would entail, and also was very patient answering my questions comprehensively beforehand and after during the recovery phase. Would certainly trust this competent surgeon to fix any future fractures I might sustain.
Mr Granville-Chapman has looked after my 15 year old son brilliantly, explaining the surgery, recovery and best way forward, and Kate has been very supportive helping with logistics etc, thank you so much.
So far my experience with Mr Jeremy Granville-Chapman has been personal and informative with regard to the operation I will be having. I feel confident that my operation will be a success and for this reason I am very happy to have Mr Jeremy Granville-Chapman as my consultant.
Very knowledgeable and helpful. Takes the time to make sure you're getting the treatment you need.
Mr Jeremy Granville -Chapman is not only a highly skilled consultant but is able to put you straight away at ease .My appointments were arranged very swiftly which was great, when you are experiencing severe pain. I am very happy with my treatment so far . many thanks to everyone who was involved in my treatment.
Polite, helpful, professional. Makes an effort to ensure full understanding of issues and procedures to be done. Highly satisfied
Very pleasant. Clear, careful explanations & options/possibilities. I feel well informed, and happy that my concerns are being well addressed, with a plan of review of the symptoms.
Excellent advise with everything explained clearly and a successful treatment which has benefited be greatly.
Spire Thames Valley hospital
Wexham Street, Wexham, Buckinghamshire, SL3 6NH
Wexham Park Hospital, Slough, Berkshire, SL2 4HL
BMI The Princess Margaret Hospital
Osborne Rd, Windsor SL4 3SJ