Distal Biceps Ruptures: One Tear, Double Trouble?
Distal Biceps Ruptures: One Tear, -Double Trouble?
A distal biceps rupture is a sudden and often painful injury where the tendon that connects the biceps muscle to the forearm tears away from the bone near the elbow. Many people hear or feel a sharp “pop”, followed by bruising, weakness, and a noticeable loss of arm strength.
Anyone can get it but this injury is most common in middle-aged men (typically in their 40s to 60s), especially those involved in lifting, sports, or manual work. It usually happens when the arm is forced to resist a heavy load—such as catching a falling object or trying to lift something too heavy.
Did You Know? Your Other Arm Is at Risk Too!
Once you’ve torn one distal biceps tendon, your other arm is at a much higher risk of suffering the same fate. Studies show that up to 8-10% of people who rupture one side will eventually rupture the other as well. This is because the same underlying tendon weakness or repetitive strain that led to the first injury is still present in the uninjured arm. The tendon is often ‘pathogenic’.
That’s why preventative strengthening, avoiding excessive strain, and knowing your options before a second injury occurs can make all the difference.
Is Surgery Necessary?
Not always! Unlike some injuries that require urgent repair, a distal biceps rupture is not compulsory to fix surgically. -Having said that, if you have this injury it is definitely worth talking about it / discussing the options early (within 1-2 weeks from injury). It all depends on how much function and strength you're willing to lose compared to the risks and benefits of surgery.
If left untreated, you can still use your arm, but there will be permanent strength loss, including:
Up to 50% loss of supination strength – Supination is the motion of rotating your palm upward, such as turning a doorknob or using a screwdriver.
Up to 30% loss of elbow flexion strength – Flexion is the action of bending your elbow, such as lifting a weight, carrying groceries, or pulling an object toward you.
For athletes, manual laborers, or highly active individuals, this loss can be significant and frustrating. However, those who don’t rely on full arm strength might adapt well without surgery.
What Happens in Surgery?
Surgical repair reattaches the torn tendon to the forearm bone (radius) using stitches, buttons, or small anchors. This restores strength and function, much better than without surgery albeit probably not like before the original injury. -But like any surgery, it comes with risks, including:
Nerve injury – Temporary numbness or weakness in the forearm or hand (rarely permanent).
Infection – As with any surgical procedure.
Re-rupture – Though uncommon with proper rehab.
Stiffness and prolonged recovery – It takes months for the tendon to heal fully.
How Long Is Recovery?
Rehabilitation is key to a successful recovery. Here’s what to expect:
First 6 weeks – Arm is in a brace or sling, with limited movement.
6-12 weeks – Gradual strength-building exercises, avoiding heavy lifting.
3-4 months – Most daily activities resume, but heavy lifting, manual work, and sports may still be restricted.
4-6 months – Full return to demanding physical tasks, sports, and weightlifting.
When Can You Drive?
Most patients can resume driving around 6 weeks post-op, depending on comfort, arm control, and surgeon approval.
Returning to Work?
Desk jobs: As early as 2 weeks post-surgery.
Light manual work: 6-8 weeks post-op.
Heavy labor jobs (lifting, construction, trades): 4-6 months post-op.
Final Thoughts: To Repair or Not to Repair?
Deciding on surgery is a personal choice. If you value full strength and function, surgery is often the best option. But if you’re willing to live with reduced arm power and adapt your activities, non-surgical management might be reasonable.
One thing to keep in mind—if you’ve already ruptured one side, your other arm is at risk. Strengthening, modifying activities, and seeking expert advice early may help prevent a second rupture.
If you're dealing with a distal biceps rupture, We can talk you through the best treatment options for your lifestyle and goals.