Distal Bicep Repair

Introduction to Distal Bicep Repair

Distal bicep tears are injuries that occur when the tendon attaching the bicep muscle to the elbow is torn from the bone. These injuries can be quite debilitating and typically require distal bicep repair surgery. Understanding the risk factors is essential for prevention and early intervention.

Age and Gender

One of the most significant risk factors for distal bicep tear is age. Individuals between the ages of 30 and 60 are more susceptible to this type of injury. Additionally, males are far more likely to experience a distal bicep tear compared to females.

Physical Activity Level

Individuals who engage in heavy lifting or strength-based sports are at a higher risk of experiencing a distal bicep tear. Weightlifting, powerlifting, and bodybuilding are common activities where these types of injuries may occur.

Preexisting Medical Conditions

Certain medical conditions can also contribute to the risk. Individuals with conditions that affect the musculoskeletal system, such as rheumatoid arthritis, are at a greater risk. Diabetes is another condition that can weaken tendons and make them more prone to tears. Specifically, known risk factors also include use of steroids and history of smoking.

Occupational Risks

Jobs that require repetitive lifting or forceful twisting motions of the arm also pose a higher risk. Construction workers, warehouse staff, and people in similar professions are more likely to experience this injury due to the nature of their work.

Use of Anabolic Steroids

Anabolic steroids are known to affect the integrity of tendons. Those who use these substances for performance enhancement in sports may be at a higher risk for distal bicep tears.

Previous Injuries

Having a history of arm or elbow injuries can make one more susceptible to a distal bicep tear. Previous injuries can weaken the tendon, making it more prone to future tears.


Understanding the risk factors associated with distal bicep tears can aid in prevention and early bicep repair treatment. While some risk factors such as age and gender are unmodifiable, awareness of other contributing elements like occupational hazards or preexisting medical conditions can be instrumental in reducing the incidence of these injuries.

Nonoperative Management of Distal Biceps Tendinitis


Distal biceps tendinitis is an inflammatory condition affecting the tendon that attaches the biceps muscle to the elbow. The management of this condition is often nonoperative, especially in the early stages. This review aims to provide an evidence-based discussion of nonoperative strategies based on prospective randomized controlled studies.

Clinical Presentation

Patients with distal biceps tendinitis typically present with localized anterior elbow pain, exacerbated by elbow flexion or supination.


The diagnosis is often clinical, confirmed by imaging studies like ultrasound or MRI to rule out severe pathology, such as tears that may necessitate surgical intervention.

Initial Management

Rest and Activity Modification

Initial treatment usually involves rest and activity modification to offload the stressed tendon.


NSAIDs are commonly used to control pain and inflammation in the acute stage.

Physical Therapy

Stretching and Strengthening

Physical therapy involving stretching and strengthening exercises targeting the biceps and surrounding musculature has been proven effective.


Other modalities such as ultrasound, cold/hot packs, and electrical stimulation may also be beneficial.

Corticosteroid Injections

In persistent or severe cases, corticosteroid injections have been considered. However, these are generally avoided in distal biceps tendinitis due to the risk of tendon rupture.

Adjunctive Therapies

Platelet-Rich Plasma (PRP)

There is emerging evidence supporting the use of PRP injections for chronic tendinitis, although its efficacy in distal biceps tendinitis is still debated.


Bracing or taping can also be used for bicep repair to temporarily relieve symptoms by restricting motion and offloading the tendon.

Long-Term Management

Lifestyle Changes

Long-term management usually involves lifestyle and ergonomic adjustments to avoid recurrence.


Nonoperative management remains the cornerstone of treatment for distal biceps tendinitis. The above-mentioned strategies, including physical therapy, medications, and possibly PRP injections, offer a range of options for effective management of this condition.

One-Incision vs Two-Incision Techniques for Distal Biceps Tendon Repair


Distal biceps tendon repair is a surgical procedure aimed at restoring the integrity of the ruptured biceps tendon at the elbow. Two common approaches are the one-incision and the two-incision techniques. This review provides an evidence-based comparison of these techniques, focusing on data from prospective randomized controlled studies.

Surgical Anatomy and Technique

Distal bicep repair

One-Incision Technique

This approach involves making a single incision over the antecubital fossa to both visualize and repair the tendon.

Two-Incision Technique

This approach involves one anterior incision over the antecubital fossa for tendon visualization and a posterior incision near the radial tuberosity for fixation.


Range of Motion

Studies show that both bicep repair techniques effectively restore range of motion, although some evidence suggests that the one-incision technique might offer slightly better elbow flexion.

Strength Recovery

Both bicep repair techniques have been shown to be effective in restoring strength. However, the one-incision technique may result in marginally better supination strength.


Nerve Injury

The two-incision technique has been associated with a higher risk of posterior interosseous nerve injury.

Infection Rates

Both techniques show similar postoperative infection rates.

Postoperative Care and Rehabilitation

Immediate Postoperative Period

Immediate postoperative care is generally similar for both techniques, involving pain management and immobilization.


The rehabilitation protocols for both techniques are generally similar, but patients with the one-incision technique may have a slightly faster return to activity.

Patient Satisfaction

Most studies indicate that patient satisfaction is comparable for both techniques, although there may be slightly higher satisfaction regarding scar appearance with the one-incision technique


Both one-incision and two-incision techniques for distal biceps tendon repair are effective surgical options. The choice between them should be individualized, taking into account various factors such as the specific nature of the injury, the surgeon’s expertise, and the patient’s preferences. However, available evidence suggests that the one-incision technique may offer some advantages in terms of range of motion, strength recovery, and lower risk of nerve injury.

Acute vs. Chronic Repair of Distal Bicep Tendon Tear


Distal bicep tendon tears require prompt medical attention, but the timing of surgical intervention can vary. This structured statement examines the differences between acute and chronic repair of distal bicep tendon tears, highlighting findings from prospective randomized controlled studies.

Timing of Intervention

Acute Distal Bicep Repair

Acute repair is generally defined as surgical intervention within two to three weeks following the injury.

Chronic Distal Bicep Repair

Chronic repair refers to surgical intervention performed more than three weeks after the initial injury.

Efficacy and Outcomes Of Distal Bicep Repair

Range of Motion

Acute bicep repair has been associated with better postoperative range of motion, especially in elbow flexion and forearm supination.

Strength Recovery

Chronic bicep repairs may yield inferior results in terms of strength recovery when compared to acute repairs.

Surgical Complexity

Scar Tissue and Contracture

Chronic cases often have increased scar tissue and muscle contracture, which can complicate the surgical procedure.

Tendon Quality

Tendon quality tends to be better in acute cases, making the repair technically easier.


Re-rupture Risk

The risk of tendon re-rupture post-surgery has been shown to be relatively similar between acute and chronic repairs.

Infection Rates

There is no significant difference in postoperative infection rates between the two Distal bicep repair approaches.

Postoperative Rehabilitation

Acute Repairs

Patients undergoing acute Distal bicep repair generally have a smoother and quicker postoperative rehabilitation course.

Chronic Repairs

Rehabilitation following chronic repair may be prolonged due to complications such as reduced tendon elasticity and muscle contractures.


Acute repair generally proves to be more cost-effective, mainly due to shorter rehabilitation periods and fewer complications.


While both acute and chronic repair of distal bicep tendon tears aim to restore function and alleviate symptoms, the available evidence suggests that acute repair often yields better outcomes in terms of range of motion, strength recovery, and overall cost-effectiveness.

Distal Bicep Tendon Reconstruction


Distal bicep tendon reconstruction is a surgical intervention to repair a ruptured or degenerated tendon at the elbow joint. This review summarizes current evidence, focusing on findings from prospective randomized controlled studies, to elucidate the benefits, risks, and postoperative considerations of the procedure.

Surgical Indications

Acute Tears

Typically, acute tears resulting from sudden trauma are prime candidates for reconstruction.

Chronic Tears

For chronic cases with ongoing pain and decreased function, reconstruction can offer relief.

Surgical Techniques


Tendon grafts harvested from the patient themselves have shown excellent results in distal bicep tendon reconstruction.


Tendon grafts from cadavers are also an option, but risk of graft rejection and disease transmission should be considered.


Range of Motion

Improvements in both flexion and supination have been observed post-reconstruction.

Strength Recovery

Most studies indicate significant strength recovery, particularly in elbow flexion and forearm supination.


Graft Failure

Although rare, graft failure remains a concern, more frequently observed in allografts.


The risk of postoperative infection is generally low but remains a significant concern.


Early Mobilization

Early mobilization post-reconstruction is generally recommended to improve range of motion.

Physical Therapy

Ongoing physical therapy is crucial for strength recovery and return to pre-injury function.


Considering the long-term benefits of successful reconstruction, most studies indicate that the procedure is cost-effective, particularly when using autografts.


Distal bicep tendon reconstruction is a promising intervention for treating both acute and chronic tendon ruptures. Surgical technique, graft choice, and postoperative rehabilitation play vital roles in determining the procedure’s success. Evidence from prospective randomized controlled studies supports the efficacy of the procedure, while also shedding light on potential complications and rehabilitation strategies.


© 2023 Dr. Robert Afra – San Diego Orthopedic Surgery Shoulder – Knee – Elbow