Biceps tendon injuries at the elbow occur with lifting heavy objects, more specifically, losing the grip on a heavy object while trying to keep it up. The tendon usually ruptures when the elbow is losing its “bend” and straightening out as you’re trying to hold something up with the elbow flexed. Sudden onset of pain in the elbow and forearm often (but not always) coupled with an audible or palpable pop. Within several days bruising develops along the elbow and forearm although the arm remains relatively usable for lighter activities.
These injuries are different than a biceps injury at the proximal (shoulder) end of the biceps. Biceps tendon injuries at the shoulder are not as critical as those at the elbow. Frequently the biceps injuries at the shoulder can be treated nonsurgically or, if surgery is necessary, on a delayed or elective basis. On the other hand, loss of the biceps at the elbow can lead to significant loss of strength. The weakness occurs not just with bending at the elbow but also with turning the forearm and palm upwards (think right hand tightening a screw or left hand loosening a screw). These are also time-sensitive and ideally are repaired within 2-3 weeks of injury for best results.
Surgical repair of distal biceps tendon ruptures is done as an outpatient. The tendon is about the size and shape of a USB drive and runs along the front of the elbow before diving deep into the forearm, where it attaches to the radius bone. Reattachment involves a combination of sutures, tunnels in the bony attachment site and occasionally a metal anchoring device. Recovery involves several days of immobilization followed by gradual resumption of light daily activities with the affected arm as well as physical therapy. This is a very successful procedure in which most people can return to normal daily activities within several weeks. However, return to vigorous activities, sports and weightlifting may take 3-4 months. Recurrent ruptures are quite rare, in fact, it is more likely that the opposite biceps tendon will sustain an injury as opposed to the repaired biceps.