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Distal biceps tendon rupture
Other Resources UpToDate PubMed

Distal biceps tendon rupture

Contributors: Thomas Rodenhouse MD, Sandeep Mannava MD, PhD
Other Resources UpToDate PubMed


Causes / typical injury mechanism: The distal biceps tendon originates from the long and short heads of the biceps brachii muscle, crosses the anterior elbow, and inserts on the radial tuberosity. This insertion allows the biceps brachii to act as both a supinator of the forearm and flexor of the elbow.

Although it is uncommon, the distal biceps tendon can rupture, typically as the result of mechanical overload during eccentric muscle contraction of a flexed elbow with the forearm in full supination.

Classic history and presentation: Patients typically experience sudden anterior elbow pain at the antecubital fossa and may hear an audible pop or snap. Subsequently, patients may demonstrate weakness on flexion of the elbow or supination of the forearm against resistance. Bruising or ecchymosis at the medial arm or in the location of the antecubital fossa, with an associated reverse "Popeye" deformity of the arm / muscle, may be seen.

Prevalence: Although incidence is classically estimated at about 1.2 per 100 000 persons each year, more recent literature suggests the incidence of distal biceps tendon ruptures to be 2.55 of 100 000 persons per year.
  • Age – Typically occurs in the fourth to sixth decades of life.
  • Sex / gender – This complication occurs vastly more often in men, up to 96% of the time.
Risk factors: Besides male sex, other risk factors include smoking, anabolic steroid use, elevated body mass index (BMI), and bodybuilding.

Pathophysiology: The pathophysiology of distal biceps rupture is likely the combination of two leading theories: impingement and hypovascularity. Mechanical impingement on the biceps tendon between the radioulnar joint during forearm rotation leads to microtrauma of the tendon. Furthermore, a watershed zone of vascularity within the tendon receiving its blood supply from the brachial artery and posterior interosseous recurrent artery is susceptible to hypovascularity. These two chronic, repetitive factors can leave the tendon weakened and susceptible to injury or rupture when an eccentric load is applied.


S46.219A – Strain of muscle, fascia and tendon of other parts of biceps, unspecified arm, initial encounter

718342006 – Tear of distal tendon of biceps brachii

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Distal biceps tendinopathy
  • Medial epicondylitis
  • Lateral epicondylitis
  • Osteoarthritis of elbow
  • Olecranon bursitis
  • Medial ulnar collateral ligament of elbow injury
  • Radial head or neck fracture
  • Olecranon fracture
  • Distal humerus fracture

Best Tests

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Management Pearls

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Reviewed:03/22/2022
Last Updated:11/21/2022
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Distal biceps tendon rupture
Copyright © 2024 VisualDx®. All rights reserved.