Performed by – Ankit Desai, Gareth Hill, Philip Rosell

The biceps muscle runs between the shoulder joint and the elbow. It flexes or bends the elbow up (moving your hand towards the shoulder) and also rotates the forearm to bring the hand palm upwards.

There are tendon attachments at both joints which can be injured. These are the long head of the biceps at the shoulder or the distal biceps tendon at the elbow.

What is a long head of biceps tendon rupture?
The long head of the biceps runs through the shoulder joint and is often a source of pain in the shoulder. It usually becomes injured or ruptured by long term wear and tear rather than a single sudden injury. When it ruptures it usually presents with a loss of the shape of the biceps muscle where the muscle drops slightly in the upper arm creating asymmetry with the opposite arm.

Usually this does not cause any weakness or loss of function and as such it does not usually require a surgical repair. If it remains painful or uncomfortable, then there are options for treatment. These will need to be discussed with your surgeon as not all are suitable for surgery or may be treated with injections and physiotherapy.

What is a biceps tendon rupture?
A distal biceps tendon rupture occurs when the tendon that connects the biceps muscle to the bone in your forearm (the radius) tears or pulls away from the bone. This tendon is essential for turning the palm upward (supination) and bending the elbow (flexion), both of which are important for daily function and strength.

This type of injury often happens suddenly during activities that involve lifting something heavy or resisting a strong pulling force—like lifting a loaded object or catching a heavy weight. You might feel a sharp “pop” in the front of the elbow, followed by immediate pain, swelling, and weakness.

A tell-tale sign is bruising in the front of the elbow and a noticeable drop in strength when trying to twist the forearm (like turning a screwdriver or opening a jar). In some cases, the biceps muscle may appear to bunch up in the upper arm—a visible change known as the “Popeye sign.”

Distal biceps rupture treatment options
If you suspect a distal biceps rupture, it’s important to seek specialist assessment quickly. At Joint Reaction, we use expert clinical evaluation and imaging—often ultrasound or MRI—to confirm the diagnosis and determine the best treatment approach.

Non-surgical treatment
Non-surgical treatment may be considered for some individuals—particularly those who are less physically active, have medical conditions that increase surgical risk, or prefer to avoid surgery. In these cases, the tendon is not reattached, and the body adapts over time by relying more on other muscles to compensate.

However, it’s important to understand the potential trade-offs. Without surgical repair, there is typically a 30% to 50% loss in supination strength (the ability to rotate the forearm, such as turning a key or using a screwdriver) and about a 20% to 30% loss in elbow flexion strength (bending the elbow against resistance). For most people, daily activities like eating, dressing, or lifting light objects can still be performed without major difficulty.

Over time, many patients adapt well, and most basic arm function can be maintained. However, if your work, hobbies, or lifestyle involve heavy lifting or strong forearm rotation, you may notice lasting weakness or fatigue with certain tasks.

At Joint Reaction, we help each patient weigh the pros and cons of non-surgical versus surgical treatment based on their specific needs and goals. A personalised rehabilitation plan can help optimise strength and mobility even if surgery is not pursued.

Surgical treatment
Surgery is generally recommended for most complete distal biceps ruptures, especially in people who rely on arm strength for work, fitness, or sports. The procedure involves reattaching the torn tendon back to the radius bone using strong sutures and modern fixation techniques. You will need to be treated in a plaster cast or brace for a few weeks after surgery to protect the repair and there will be restrictions on how much you can lift or load the arm for a few months.

At Joint Reaction, our surgeons are highly experienced in distal biceps tendon repair. We use safe, efficient surgical methods designed to restore full function and minimize the risk of complications. After surgery, patients follow a structured rehabilitation program to gradually regain movement, strength, and confidence. When treated promptly, most patients can expect a strong return to normal activities within a few months.