The biceps brachii muscle is the large muscle at the front of the arm. It originates from two heads at the top of the shoulder and inserts below the elbow at the radial tuberosity. If the biceps becomes ruptured (completely torn) due to trauma or from chronic degeneration, then it can cause weakness in the forearm and elbow. A distal biceps rupture means that it has torn from the attachment point below the elbow.
For a full rupture of the distal biceps tendon to occur, there is normally an acute traumatic event. Commonly, a sudden heavy force or weight is applied to the hand or forearm as the elbow is moving from a flexed position (bent) to an extended position (straight). For example, reaching out to catch a falling object. Partial tears can occur due to chronic degeneration.
The biceps tendon migrates proximally, as seen in the image below. This is often called the ‘popeye sign’. Patients can report a sudden onset of pain at the time of injury but this is normally very short-lasting.
Weakness is evident with forearm supination (turning the palm up towards the ceiling) and, to a lesser extent, elbow flexion. Additionally, you might have bruising and swelling along the upper arm.
Distal biceps ruptures require urgent surgical repair to reattach the torn tendon.
Following surgery, you will be required to follow the post-operative instructions from your surgeon. Typically this involves wearing a sling followed by either a hinged elbow brace or thermoplastic elbow splint for up to 6 weeks post-operatively.
Scar management will be provided by your treating therapist and you will also be required to carry out regular scar massage on a daily basis. Your therapist will guide you through an appropriate rehabilitation exercise programme. This will initially focus on an assisted range of motion through the limited range, which will be progressively increased to achieve full elbow range of motion, normally by 6 weeks post-op. Commencement of strengthening exercises will be dependent on your specific surgeon’s advice and post-operative instructions. Many surgeons do not allow strengthening until 12 weeks following surgery.
If you suspect that you have a distal biceps rupture then you must seek medical attention urgently.
At Melbourne Hand Therapy we can assist in providing a quick diagnosis and guide you through the referral pathway to see a surgeon for urgent consultation and surgery.
Following your surgery, we can provide you with the appropriate splint or brace that your surgeon has recommended and will progressively rehabilitate your arm to allow you to return to full function.