A biceps that suddenly snaps

You lift something heavy with your arm straight or hit a punching bag during boxing training and feel a sharp pain near the crook of your elbow, as though something has torn.

Avulsion of the distal tendon attachment of the biceps brachii

You hear or feel a distinct snap. Within a few hours, your forearm turns blue and the contour of your upper arm changes. This is not an ordinary biceps strain. It is a serious avulsion of the distal biceps tendon attachment.

What is actually happening?

The biceps tendon crosses the elbow joint and attaches to the radius in the forearm, just below the elbow. This muscle is chiefly responsible for turning the forearm outward, for example when driving in a screw, and to a lesser extent for bending the elbow. When the elbow suddenly and forcefully straightens while the muscle is tense, for example when a carried load pulls you off balance, the force can exceed what the tendon can withstand and it tears away from the bone.

The tear most often occurs when lifting a very heavy object, and the risk increases with strength training and power sports. Over time, the tendon develops microtraumas or degeneration and tears under sudden load.

How do you recognize it

  • sharp pain right at the elbow crease at the moment of injury, sometimes with a palpable snap,
  • bruising and swelling of the elbow and forearm,
  • the upper-arm muscle sits higher than usual and changes its contour,
  • marked weakness when rotating the forearm; for example, you cannot turn a key forcefully in a lock.

Why you should not wait

A tendon torn away from the bone will not reattach by itself. Without tension, the muscle becomes shorter from week to week and loses elasticity. After some time it is too short to reach its original attachment, even during surgery.

An operation performed soon after the injury usually restores the tendon to its natural position without difficulty. If delayed, it is technically more difficult, sometimes requires an additional graft to lengthen the tendon and increases the risk of contracture.

How we help

We begin with a consultation and ultrasound, which confirms whether the tendon is partially or completely torn and how far the muscle has retracted toward the upper arm. The earlier this examination is performed and the diagnosis confirmed, the easier it is to reattach the tendon surgically in its natural position before it contracts and becomes covered with scar tissue.

In older patients with modest demands or contraindications to surgery, conservative treatment may be sufficient: cooling, relieving the arm and rehabilitation to adapt it to work without this tendon.

In other patients, especially those who are physically active, we operate: we find the detached tendon, free it from scar tissue and reattach it to the radius through a channel made in the bone, restoring full strength for bending and rotating the forearm.

There is one goal: a hand you can once again rotate and use to lift objects with full strength, while the arm returns to its normal appearance.

Book a consultation

If you suspect this injury, do not wait, because surgery becomes more difficult with each week. Book a consultation. We will assess how serious the tear is and tell you whether rehabilitation is sufficient or a procedure is needed.