Distal Biceps Avulsion


  • The biceps tendon avulses from its insertion on the radial tuberosity


  • Usually a sudden strain to the biceps muscle causes it to tear off the radial tuberosity.

    Eg – heavy lifting or tackles


  • The pain is felt initially in the front of the elbow and cubital fossa. Occasionally there is early bruising.
  • The biceps muscle migrates slightly proximally and there is an obvious asymmetry between the biceps muscles on both sides.
  • Clinical examination shows absence of the taut biceps tendon in the cubital fossa.
  • An MRI or ultrasound can help confirm the diagnosis.


  • Surgical – general anaesthetic
  • An incision is made in the forearm and dissection carried out down to the radial tuberosity.
  • Occasionally an additional incision is made further in the upper arm to retrieve the tendon, if it is retracted.
  • The tendon is then inserted back into the radial tuberosity, through the use of a drill hole and can be secured here, either with suture anchors and endobutton.
  • Occasionally, in chronic tears, a palmaris longus graft is required to bridge the gap.

Potential Complications

  • Haematoma, neurovascular injury.
  • Stiffness to the elbow
  • Re-rupture of the repair

Post Op Care

  • The patient is normally discharged in a polysling.
  • Extension is slowly regained over approximately a six week period.
  • Specialist review at ten days for wound inspection and stitch removal.
  • Review at six weeks and three months
  • Expect return to normal duties by three months
  • Aim to improve strength of supination and elbow flexion
University Of Auckland Auckland Born Joint Surgery Fracs NZOA  University Of Auckland Auckland Born Joint Surgery Fracs