Distal Biceps Rupture Info In-depth Evidence
Reviewed by Dr Kieran Hirpara, Specialist Orthopaedic Surgeon Last reviewed
What you're feeling
You might hear or feel a sudden snap or pop in your arm. This often happens when you lift something heavy or fall onto your outstretched hand. The pain is usually sharp and immediate. You may notice swelling and bruising appear quickly around the front of your elbow.
Your bicep muscle may look different. It can bunch up higher in your upper arm, creating a visible dent near the elbow. This change in shape is common after a rupture. You will likely feel weak when trying to bend your elbow or turn your palm upward. Many people find it difficult to hold objects or perform daily tasks with that arm.
In the first few days, pain may be worse at night or when you move your arm. You might feel reluctant to use the limb because of the discomfort. As healing begins, the sharp pain usually settles into a duller ache. Swelling and bruising may spread down your forearm over the first week.
Most patients are able to return to work and sport after surgical repair. However, you should expect some residual impairment compared with how you felt before the injury. One in five patients will have a minor complication after surgery on the distal biceps tendon. These are often sensory nerve injuries that resolve with time. One in twenty patients will have a major complication.
If you chose not to have surgery, thirty-six percent of patients with complete or partial tears eventually undergo conversion to surgery. This is because nonsurgical treatment does not always restore full function. Surgical management of complete tears is a predictor of improved patient-reported outcomes.
All patients undergoing distal biceps tendon repair have significant elongation of their repair site and tendon after surgery. The greatest amount of lengthening is seen in the early post-operative period. Despite this, clinical and functional outcomes at more than one year after distal biceps tendon repair are excellent. You can expect high levels of return to sport following distal biceps repair.
What's actually happening
Your biceps muscle sits in the front of your upper arm. It ends in a strong tendon that attaches to a small bump on your forearm bone. This connection allows you to bend your elbow and twist your palm upwards. When the tendon tears away from this bone, it is like a rope snapping from its anchor point.
Right now, your arm cannot generate normal twisting or bending strength. The muscle belly may bunch up higher in your arm because it is no longer pulled tight against the forearm. This creates a visible gap and a loss of power. You might find it difficult to lift objects or turn a doorknob.
The goal of repair is to reattach that tendon to the bone. We use special anchors to hold the tendon in place while your body heals itself. Over time, new tissue forms between the tendon and the bone, effectively knitting them back together. This restores the mechanical link needed for strength.
Healing takes time. The initial attachment is strong, but the biological bond strengthens gradually over months. During this period, your surgeon will guide you through specific movements to protect the repair while preventing stiffness.
Complications are possible but not common. Major issues occur in about 7.5% of cases, with a 4.5% chance of needing further surgery. Most people recover well, with excellent long-term function reported for many techniques. Some patients may develop extra bone growth in the forearm muscles, known as heterotopic ossification. This can sometimes limit movement, but many patients maintain good strength despite this change.
If you choose not to have surgery, some people live with reduced strength. However, about 36% of those who initially avoid surgery later decide to have the repair done. This is often because the weakness becomes too limiting for daily tasks or work. Your surgeon will help you weigh these options based on your specific tear and lifestyle needs.
What we can do about it
Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, starts with the least invasive options that suit your condition. Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate. A clinic assessment establishes the diagnosis. For structural or acute problems, surgery may be recommended straight away, without a preceding non-operative trial.
If your tear is stable or minimally displaced, we may recommend non-operative care. This involves wearing a sling, splint, or cast to protect the tendon while it heals. You will monitor your progress with repeat imaging where needed. Staged return to movement with physiotherapy follows. Nonoperative treatment for partial distal biceps tendon tears yields moderate success rates (47%) with no significant differences between strategies, though injection therapy offers the quickest relief.
If your tear is displaced, unstable, or complete, we recommend surgery from the outset. This aims to reattach the tendon to restore strength and function. Surgical management of distal biceps tears was a predictor of improved patient-reported outcomes only for patients with complete tears. The majority of patients are able to return to work and sport after surgical repair of distal biceps rupture. Distal biceps repair is associated with a 7.5% major complication rate and a 4.5% reoperation rate. One in 5 patients will have a minor complication and 1 in 20 patients will have a major complication after surgery on the distal biceps tendon.
Both paths share early pain control, protection of the injury, and timely physiotherapy. Early motion after distal biceps tendon repair with cortical button fixation is well tolerated and does not appear to be associated with adverse outcomes. Patients can expect high levels of return to sport following distal biceps tendon repair with some residual impairment compared with baseline. Workers' compensation patients who underwent distal biceps tendon repair took longer to return to work and had worse DASH scores than non-workers' compensation patients.
What to expect
Your arm will feel stiff and weak at first. This is normal. The tendon needs time to reattach to your bone. Most patients notice the greatest lengthening of the muscle in the early weeks after surgery. You will likely feel a difference in how your arm looks and feels for several months.
Healing is a slow process. You can expect significant improvement over the first year. Maximum recovery typically plateaus at 12 months. By this time, most people have regained near-normal strength for bending the elbow and turning the palm upward. Clinical outcomes remain excellent one year after repair, regardless of the fixation method used.
Returning to daily tasks is usually straightforward. Most patients are able to return to work and sport after surgical repair. The average time to return to work is just beyond 14 weeks. However, workers’ compensation patients often take longer to return and report lower functional scores than others. You should expect high levels of return to sport by six months, though some residual weakness may remain compared to your baseline.
Non-surgical treatment is an option, but it carries risks. Thirty-six percent of patients who initially avoid surgery eventually require conversion to an operation. Without repair, you may experience lasting weakness and fatigue when lifting objects.
Complications are possible but generally low. Distal biceps repair is associated with a 7.5% major complication rate and a 4.5% reoperation rate. One in five patients will experience a minor complication, such as temporary nerve irritation that causes numbness or tingling. These minor issues usually resolve with time. A small number of patients develop heterotopic ossification, where extra bone forms between the upper and lower arm bones. Even in these cases, biceps strength is often maintained with no measurable difference in clinical outcome compared to those without this condition.
Your surgeon will guide you through a safe rehabilitation plan. Early motion is often well tolerated and does not appear to cause adverse outcomes. We aim to restore your function while protecting the repair.
When to see someone
Seek urgent care if you notice a visible deformity, have an open wound, experience numbness or tingling, or cannot use your arm. These signs need immediate attention.
If pain is not settling, or if swelling, movement, and function are not improving week on week as healing progresses, see your GP or ask for a specialist review. Your surgeon can assess whether your recovery is on track. Early assessment helps manage any minor issues before they become major problems. Most patients recover well, but timely checks ensure you get the right support.
Advanced reading: the deeper science (optional)
This section goes further than you need for your own treatment decisions. Distal biceps rupture is worth the extra reading because it is one of the few injuries on this site where surgery demonstrably restores something that healing without it does not — which makes the trade-off unusually concrete, and the complication figures unusually relevant.
Here, the operation does change function
Most of the comparisons on this site end in "no significant difference". This one does not. Pooling 2,481 patients, operative treatment produced superior elbow and forearm strength and endurance, along with better DASH and Mayo Elbow Performance scores, than non-operative management [1].
The reason is anatomical rather than statistical. The distal biceps is the main supinator of the forearm — the muscle that turns the palm upwards against resistance. When the tendon detaches from the radius it retracts up the arm, and the muscle can no longer generate that rotation, whatever else heals around it. Elbow flexion is partly covered by brachialis, so bending the elbow recovers reasonably well; supination has no comparable understudy.
That is why the loss shows up most clearly in endurance rather than a single maximal effort. Repeated turning — a screwdriver, a door handle, a steering wheel over a long drive — is where the difference is felt.
The complication rate is the other half of the decision
An operation that reliably restores strength is still an operation, and this one has a well characterised profile. In the largest analysis, covering 3,091 patients, the major complication rate was 4.6% [2].
Most of what occurs is minor and temporary — numbness over the back of the forearm from traction on a small sensory nerve is the commonest, and usually recovers. The major complications are the ones that shape technique: permanent nerve injury, heterotopic ossification (new bone forming across the forearm and restricting rotation), and re-rupture.
Two approaches, and the trade-off is genuine
The repair is done either through a single incision at the front of the elbow or through two smaller ones, front and back. Both reach the same bone from different directions, and each avoids a different hazard.
Across 2,622 patients there were no significant differences in functional scores. The single-incision approach gave greater flexion and pronation range of motion and a lower risk of heterotopic ossification and reoperation, while the double-incision approach was more favourable on other measures [3]. A 2025 meta-analysis of 2,833 patients found the same shape: single incision associated with more favourable objective function and fewer structural complications, double incision with reduced risk of certain sensory nerve injuries [4].
Read together, the choice is between the nerve at the front and the bone at the back. Neither approach is wrong, and both sets of authors call for higher-quality randomised trials before the question is considered closed.
Why the timing matters more than it does elsewhere
Because the tendon retracts and the space it occupied scars, delay makes reattachment harder — and where direct repair is no longer possible, reconstruction with a graft becomes necessary. This is the practical reason a distal biceps rupture is treated with more urgency than most tendon injuries, and why a sudden painful pop at the front of the elbow, with visible change in the shape of the muscle, is worth prompt assessment rather than a period of watchful waiting.
Non-operative management remains a legitimate choice, particularly for lower-demand arms and for people who do not need forceful repeated supination. It is a decision to accept a measurable deficit, made deliberately — not a lesser version of the same result.
References for the advanced reading
- Looney AM, Day J, Bodendorfer BM, Wang D, Fryar CM, Murphy JP, et al. Operative vs. nonoperative treatment of distal biceps ruptures: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2022;31(4):e169-e189.
- Amarasooriya M, Bain GI, Roper T, Bryant K, Iqbal K, Phadnis J. Complications after distal biceps tendon repair: a systematic review. Am J Sports Med. 2020;48(12):3103-11.
- Castioni D, Mercurio M, Fanelli D, Cosentino O, Gasparini G, Galasso O. Single- versus double-incision technique for the treatment of distal biceps tendon rupture: a systematic review and meta-analysis of comparative studies. Bone Joint J. 2020;102-B(12):1608-17.
- Awad G, Boutros M, Hajj Youssef M, Elhassan B. Comparing single-incision and double-incision techniques in distal biceps tendon repair: a systematic review and meta-analysis. Shoulder Elbow. 2025.
Evidence & references
This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.
Overview
- Surgical treatment of chronic distal biceps injuries yields favorable objective and subjective outcomes [1].
- The short-term clinical influence of biceps complications on shoulder outcome is very limited [2].
- The overall frequency of reported complications is higher for single-incision distal biceps repair than for double-incision repair [3].
- Surgical repair of distal biceps tendon ruptures has an overall low rate of serious complications regardless of approach or technique [4].
- Bioabsorbable interference screw fixation of distal biceps ruptures through a single anterior incision is a safe and successful technique for the management of distal biceps tendon ruptures [7].
- Complication rates after distal biceps repair are low [8].
- Patients undergoing distal biceps reconstruction with graft augmentation can expect low complications and good functional results [10].
- Direct repair in the acute setting is preferred over reconstruction with graft augmentation [10].
- Distal biceps repair is associated with a 7.5% major complication rate [12].
- Distal biceps repair is associated with a 4.5% reoperation rate [12].
Anatomy & Pathophysiology
- Thorough knowledge of distal biceps insertional and footprint anatomy is essential for understanding the biomechanics of rupture and reconstruction, and for avoiding nerve injuries [32].
- Distal biceps MRI signal changes consistent with tendinopathy are common in asymptomatic elbows, reducing the probability that symptoms correlate with imaging pathology [29].
- Nonoperative management does not restore function to the elbow in cases of chronic biceps tendon rupture [24].
- Nonoperative treatment of distal biceps rupture may lead to permanent loss of arm function [50].
- Surgical repair of the distal biceps insertion reliably regains both supination and flexion strength in appropriate patients [44].
- Distal biceps repair or reconstruction can restore near-normal flexion and supination strength [42].
- Surgical repair restores supination strength, although outcomes vary [43].
- Operative treatment results in superior elbow and forearm strength and endurance, as well as superior DASH and MEPS scores, compared to nonoperative management [41].
- For patients with higher-demand occupations, surgical repair results in a greater likelihood of rating elbow function as much better compared to nonoperative management [26].
- Most methods of fixation provide adequate strength to allow early active range of motion, with complications being similar between groups using modern surgical techniques [47].
- There is no significant difference in range of motion and strength between different approaches and fixation techniques for distal biceps tendon ruptures [48].
- Fixation constructs using an extramedullary cortical button with or without an interference screw, or two intramedullary cortical buttons, demonstrate biomechanical properties comparable to or superior to the native tendon [45].
Classification
- Partial distal biceps tendon tears encompass a spectrum of disease with variable presentation and morphology [6].
- Isolated short head ruptures are a rare and distinct form of distal biceps tear that present with consistent clinical findings that can aid in diagnosis [11].
- The surgical repair of distal biceps tendon ruptures has an overall low rate of serious complications, regardless of approach or technique [13].
- The evidence-based diagnostic algorithm using the combination of the Flexion Initiation Test (FIT) and hook test demonstrates high accuracy for the diagnosis of both complete and high-grade partial distal biceps tendon tears [16].
- The modified two-incision approach is the current gold standard for distal biceps tendon repairs, though anterior approaches are also effective with similar rerupture rates [20].
- The incidence of women sustaining a distal biceps tendon tear is 3.2%, with partial tears being statistically more common than complete ruptures [22].
- Anterior single incision techniques were used in the majority of cases in a large cohort study of distal biceps tendon repairs, with varying fixation methods [38].
Clinical Presentation
- Chronic distal biceps injuries present with a spectrum of disease where surgical treatment yields favorable objective and subjective outcomes [1].
- Biceps-related complications after tenotomy associated with arthroscopic rotator cuff repair have very limited short-term clinical influence on shoulder outcome [2].
- Isolated distal biceps femoris injuries occurred primarily via noncontact mechanisms [18].
- The prevalence of distal biceps tendon signal changes on MRI in asymptomatic patients is very low [23].
Investigations
- Distal biceps MRI signal changes consistent with tendinopathy are common even in asymptomatic elbows, which reduces the probability that symptoms correlate with pathology on imaging [29].
Treatment
- Surgical management of chronic distal biceps ruptures demonstrates improvement in outcomes including pain reduction and functional ability [9].
- Bioabsorbable interference screw fixation of distal biceps ruptures through a single anterior incision is a safe and successful technique [7].
- The early complication rate following partial distal biceps tendon repair was 20.5% [19].
- Distal biceps repair is associated with a 7.5% major complication rate and 4.5% reoperation rate [12].
- Surgical management of distal biceps tears was a predictor of improved patient-reported outcomes only for patients with complete tears [17].
- The results of the meta-analysis showed the superiority of surgical management over the nonoperative approach for distal biceps tendon detachment, with superior flexion and supination strength and better patient-reported outcomes [34].
- For patients with higher-demand occupations, surgical repair resulted in a greater likelihood of rating elbow function as much better compared to nonoperative management [26].
- Workers' compensation patients who underwent distal biceps tendon repair took longer to return to work and had worse DASH scores than non-workers' compensation patients [40].
- Nonoperative management does not restore function to the elbow [24].
Complications
- Patients should be counseled that 1 in 5 patients will have a minor complication and 1 in 20 patients will have a major complication after surgery on the distal biceps tendon [21].
- Complication rates after distal biceps tendon repair performed by newly trained surgeons were similar to those previously reported in large cohort studies, with nerve injury as the most common complication [25].
- This is the largest analysis of complications after distal biceps repair, indicating a major complication rate of 4.6% [31].
Recovery
- Direct repair in the acute setting is preferred, but patients undergoing distal biceps reconstruction with graft augmentation can expect low complications and good functional results [10].
- The modified two-incision approach is the current gold standard, though anterior approaches are also effective with similar rerupture rates [20].
- One in five patients will have a minor complication and one in twenty patients will have a major complication after surgery on the distal biceps tendon [21].
- Even in the setting of a distal biceps reconstruction with graft augmentation, patients can expect a similar result to primary repair [27].
- The average time to return to work after distal biceps repair in the literature was just beyond 14 weeks [46].
- Timing significantly impacts surgical technique selection in distal biceps ruptures, with direct repair favored for acute injuries and high flexion angle repair or allograft reconstruction for chronic cases [51].
Key Evidence
- [L1] Surgical treatment of chronic distal biceps injuries yields favorable objective and subjective outcomes. [1] (10.1016/j.xrrt.2022.02.007)
- [L3] Nevertheless, the short-term clinical influence of biceps complications on shoulder outcome is very limited. [2] (10.1177/2325967121s00362)
- [L1] The overall frequency of reported complications is higher for single-incision distal biceps repair than for double-incision repair. [3] (10.1177/2325967116668137)
- [L3] Surgical repair of distal biceps tendon ruptures has an overall low rate of serious complications regardless of approach or technique. [4] (10.1016/j.jse.2017.06.021)
- [L5] Partial distal biceps tendon tears encompass a spectrum of disease with variable presentation and morphology. [6] (10.1177/17585732241245054)
- [Paper] This is a safe and successful technique for the management of distal biceps tendon ruptures. [7] (10.1007/s00402-009-0974-x)
- [L3] Complication rates after distal biceps repair are low. [8] (10.5397/cise.2021.00472)
- [L4] Surgical management of chronic distal biceps ruptures demonstrates improvement in outcomes including pain reduction and functional ability. [9] (10.1177/23259671211065772)
- [L3] Patients can be consulted that direct repair in the acute setting is preferred; however, even in the setting of a distal biceps reconstruction with graft augmentation, they can expect low complications and good functional results. [10] (10.1016/j.jseint.2020.10.023)
- [L4] Isolated short head ruptures are a rare and distinct form of distal biceps tear that present with consistent clinical findings that can aid in diagnosis. [11] (10.1016/j.jse.2020.04.038)
- [L3] Distal biceps repair is associated with a 7.5% major complication rate and 4.5% reoperation rate. [12] (10.1016/j.jse.2018.06.028)
- [L3] The surgical repair of distal biceps tendon ruptures has an overall low rate of serious complications, regardless of approach or technique. [13] (10.1177/0363546517720200)
- [L4] The evidence-based diagnostic algorithm using the combination of the FIT and hook test demonstrates high accuracy for the diagnosis of both complete and high-grade partial distal biceps tendon tears. [16] (10.1016/j.asmr.2021.01.010)
- [L2] Surgical management of distal biceps tears was a predictor of improved patient-reported outcomes only for patients with complete tears. [17] (10.1016/j.jhsa.2025.12.027)
- [L4] Isolated distal biceps femoris injuries occurred primarily via noncontact mechanisms. [18] (10.1177/2325967118781828)
- [L4] The early complication rate following partial distal biceps tendon repair was 20.5%. [19] (10.1016/j.jhsa.2025.04.012)
- [L5] This narrative review summarizes the history, anatomy, and controversies surrounding distal biceps tendon ruptures and repairs, highlighting that the modified two-incision approach is the current gold standard, though anterior approaches are also effective with similar rerupture rates. [20] (10.1016/j.jse.2016.05.025)
- [L4] Patients should be counseled that 1 in 5 patients will have a minor complication and 1 in 20 patients will have a major complication after surgery on the distal biceps tendon. [21] (10.1016/j.jse.2016.02.032)
- [L4] The incidence of women sustaining a distal biceps tendon tear is 3.2%, with partial tears being statistically more common than complete ruptures. [22] (10.1016/j.jse.2014.02.006)
- [L3] The prevalence of distal biceps tendon signal changes on MRI in asymptomatic patients is very low. [23] (10.1016/j.jhsa.2022.01.020)
- [L5] Nonoperative management does not restore function to the elbow. [24] (10.1007/s11552-013-9551-4)
- [L4] Complication rates after distal biceps tendon repair performed by newly trained surgeons were similar to those previously reported in large cohort studies, with nerve injury as the most common complication. [25] (10.1016/j.jse.2022.09.014)
- [L4] For patients with higher-demand occupations, surgical repair resulted in greater likelihood of rating elbow function as much better compared to nonoperative management. [26] (10.1016/j.jse.2017.12.010)
- [L3] Patients can be consulted that even in the setting of a distal biceps reconstruction with graft augmentation, they can expect a similar result to primary repair. [27] (10.1016/j.jse.2020.01.062)
- [L4] The finding that distal biceps MRI signal changes consistent with tendinopathy are common even in asymptomatic elbows reduces the probability that symptoms correlate with pathology on imaging. [29] (10.5397/cise.2023.00164)
- [L2] This is the largest analysis of complications after distal biceps repair, indicating a major complication rate of 4.6%. [31] (10.1177/0363546519899933)
- [L4] Thorough knowledge of the anatomy is essential for the surgeon in order to understand the biomechanics of rupture and reconstruction of the distal biceps tendon and to avoid injuries of the nerves. [32] (10.1007/s00167-014-3322-9)
- [L1] The results of this meta-analysis showed the superiority of surgical management over the nonoperative approach for distal biceps tendon detachment, with superior flexion and supination strength and better patient-reported outcomes. [34] (10.1177/23259671211037311)
- [L3] The study examined clinical and surgical outcomes for distal biceps tendon repairs in a large cohort, finding that anterior single incision techniques were used in the majority of cases with varying fixation methods. [38] (10.1016/j.jse.2016.12.053)
- [L3] WC patients who underwent distal biceps tendon repair took longer to return to work and had worse DASH scores than non-WC patients. [40] (10.1016/j.jse.2012.11.011)
- [L1] Operative treatment resulted in superior elbow and forearm strength and endurance, as well as superior DASH and MEPS scores compared to nonoperative management. [41] (10.1016/j.jse.2021.12.001)
- [L5] Distal biceps repair/reconstruction can restore near-normal flexion and supination strength. [42] (10.1016/j.jhsa.2019.09.014)
- [L5] Surgical repair restores supination strength, though outcomes vary. [43] (10.1016/j.jhsa.2012.02.008)
- [L4] Surgical repair of the distal biceps insertion reliably regains both supination and flexion strength in appropriate patients. [44] (10.5435/00124635-201003000-00003)
- [L1] The fixation constructs that consistently demonstrated comparable or better biomechanical properties to native tendon were the extramedullary cortical button with or without interference screw and two intramedullary cortical buttons. [45] (10.1016/j.arthro.2022.08.037)
- [L4] The average time to return to work after distal biceps repair in the literature was just beyond 14 weeks. [46] (10.1016/j.jse.2019.12.006)
- [L4] Most methods of fixation provide adequate strength to allow early active range of motion, and complications are similar between groups using modern surgical techniques. [47] (10.1016/j.jse.2010.11.009)
- [L2] There was no significant difference in range of motion and strength between the different approaches and fixation techniques. [48] (10.1016/j.jse.2015.09.004)
- [L4] Nonoperative treatment may lead to a degree of permanent loss of function of the arm. [50] (10.1177/03635465990270020201)
- [L3] Timing significantly impacts surgical technique selection in distal biceps tendon ruptures, with direct repair favored for acute injuries and high flexion angle repair or allograft reconstruction for chronic cases. [51] (10.1016/j.jse.2025.07.027)
References
[1] Outcomes and complications after different surgical techniques for the treatment of chronic distal biceps tendon ruptures: a systematic review and quantitative synthesis. JSES Reviews, Reports, and Techniques. 2022. DOI: 10.1016/j.xrrt.2022.02.007
[2] Biceps-related complications after tenotomy associated with arthroscopic rotator cuff repair: risk factors and clinical impact. Orthopaedic Journal of Sports Medicine. 2022. DOI: 10.1177/2325967121s00362
[3] Complications of Distal Biceps Tendon Repair. Orthopaedic Journal of Sports Medicine. 2016. DOI: 10.1177/2325967116668137
[4] Analysis of 784 surgically treated distal biceps tendon ruptures. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2017.06.021
[6] Current concepts in the aetiology, assessment and management of partial distal biceps tendon tears. Shoulder & Elbow. 2024. DOI: 10.1177/17585732241245054
[7] Bioabsorbable interference screw fixation of distal biceps ruptures through a single anterior incision: a single-surgeon case series and review of the literature. Archives of Orthopaedic and Trauma Surgery. 2009. DOI: 10.1007/s00402-009-0974-x
[8] Determining the incidence and risk factors for short-term complications following distal biceps tendon repair. Clinics in Shoulder and Elbow. 2022. DOI: 10.5397/cise.2021.00472
[9] Surgical Results of Chronic Distal Biceps Ruptures: A Systematic Review. Orthopaedic Journal of Sports Medicine. 2022. DOI: 10.1177/23259671211065772
[10] Outcomes of chronic distal biceps reconstruction with tendon grafting: a matched comparison with primary repair. JSES International. 2021. DOI: 10.1016/j.jseint.2020.10.023
[11] Distal biceps short head tears: repair, reconstruction, and systematic review. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.04.038
[12] Major complications after distal biceps tendon repairs: retrospective cohort analysis of 970 cases. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2018.06.028
[13] Surgical Treatment of Distal Biceps Tendon Ruptures: An Analysis of Complications in 784 Surgical Repairs. The American Journal of Sports Medicine. 2017. DOI: 10.1177/0363546517720200
[16] The Flexion Initiation Test and an Evidence‐Based Diagnostic Algorithm for Distal Biceps Tendon Tears. Arthroscopy, Sports Medicine, and Rehabilitation. 2021. DOI: 10.1016/j.asmr.2021.01.010
[17] Thirty-Six Percent Conversion to Surgery Rate for Nonsurgical Treatment of Complete and Partial Distal Biceps Tears. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2025.12.027
[18] Isolated Tearing and Avulsion of the Distal Biceps Femoris Tendon During Sporting Activities: A Systematic Review. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967118781828
[19] Early Postoperative Complications Following Partial Distal Biceps Tendon Surgical Repair. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2025.04.012
[20] Distal biceps tendon history, updates, and controversies: from the closed American Shoulder and Elbow Surgeons meeting—2015. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2016.05.025
[21] Factors associated with adverse events after distal biceps tendon repair or reconstruction. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2016.02.032
[22] Re-rupture rate of primarily repaired distal biceps tendon injuries. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2014.02.006
[23] Evaluation of MRI Signal Changes of the Distal Biceps Tendon in Asymptomatic Patients. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2022.01.020
[24] Treatment of Chronic Biceps Tendon Ruptures. HAND. 2013. DOI: 10.1007/s11552-013-9551-4
[25] Trends and complications of distal biceps tendon repair among American Board of Orthopaedic Surgery part II oral examination candidates. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2022.09.014
[26] Is nonoperative management of partial distal biceps tears really successful?. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2017.12.010
[27] Chronic Distal Biceps Repair with Tendon Grafting: A Matched Comparison to Primary Repair. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.01.062
[29] Prevalence of incidental distal biceps signal changes on magnetic resonance imaging. Clinics in Shoulder and Elbow. 2023. DOI: 10.5397/cise.2023.00164
[31] Complications After Distal Biceps Tendon Repair: A Systematic Review. The American Journal of Sports Medicine. 2020. DOI: 10.1177/0363546519899933
[32] Clinical relevance of distal biceps insertional and footprint anatomy. Knee Surgery, Sports Traumatology, Arthroscopy. 2014. DOI: 10.1007/s00167-014-3322-9
[34] Operative Versus Nonoperative Management for Distal Biceps Brachii Tendon Lesions: A Systematic Review and Meta-analysis. Orthopaedic Journal of Sports Medicine. 2021. DOI: 10.1177/23259671211037311
[38] The distal biceps deficient arm, “the short arc syndrome”. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2016.12.053
[40] Outcomes after distal biceps repair in patients with workers' compensation claims. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2012.11.011
[41] Operative vs. nonoperative treatment of distal biceps ruptures: a systematic review and meta-analysis. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2021.12.001
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