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What is Distal Biceps Tear?

  • The biceps tendon crosses the front of the elbow joint and bends (flexes) the elbow. Tears of the distal biceps tendon at the elbow are uncommon, and injuries are frequently sudden. The tear can be complete (full thickness) where the tendon is torn from the bone, or partial. In partial tears the tendon is not completely severed.

How do you know if you have a partial Distal Biceps Tear?

  • The main cause of a distal biceps tendon tear is a sudden injury, forcing the elbow straight against resistance pulling the tendon off the bone. Often there is a “pop” at the elbow when the tendon tears and subsequent swelling and bruising over the front of the elbow. Patients often have weakness and a bulge in the front of the upper part of the arm with full-thickness tears. In partial tears, patients may only have pain over the front of the elbow.

What are the treatments for distal biceps tendon partial tears or tendinopathy?

Conservative Treatment

  • In most cases, tears of the distal biceps tendon are complete. Once the entire tendon is torn from the bone, the tendon will not grow back. Treatment of partial tears includes rest, ice, medication, and physical therapy. In the past, when these traditional conservative treatments failed, surgery was the only option recommended to patients.

Ultrasound-Guided Needle Tenotomy (TENEX)

  • Percutaneous needle tenotomy was first described by McShane et al in 2006, and involved repeatedly fenestrating the diseased tendon. This disrupted the abnormal tendon and stimulated a healing response.

  • The Tenex needle uses ultrasonic technology to perform the tenotomy, and has a high rate of success when compared to a simple percutaneous needle tenotomy. The first study looking at Tenex by Koh et al. in 2013 showed that 95% of patients were satisfied with the procedure

  • Learn more about Tenex here


  • Barker et. al. studied 6 patients who underwent an ultrasound-guided PRP injection, which showed to be a safe and effective treatment for recalcitrant cases of distal biceps tendinopathy. Further investigation with a randomized controlled trial is needed to fully assess its efficacy.

  • Unlike cortisone injections, PRP should not wear off and will hopefully heal the tendon. When comparing PRP to steroids in the lateral epicondyle, Gosens et al. showed PRP to be more effective.

  • Learn more about PRP injections here


  • Barker SL, Bell SN, Connell D, Coghlan JA. Ultrasound-guided platelet-rich plasma injection for distal biceps tendinopathy. Shoulder Elbow. 2015 Apr;7(2):110-4. doi: 10.1177/1758573214567558. Epub 2015 Jan 16. PMID: 27582965; PMCID: PMC4935115.
  • Koh JS, Mohan PC, Howe TS, Lee BP, Chia SL, Yang Z, Morrey BF. Fasciotomy and surgical tenotomy for recalcitrant lateral elbow tendinopathy: early clinical experience with a novel device for minimally invasive percutaneous microresection. Am J Sports Med. 2013 Mar;41(3):636-44. doi: 10.1177/0363546512470625. Epub 2013 Jan 9. PMID: 23302261.
  • McShane JM, Nazarian LN, Harwood MI. Sonographically guided percutaneous needle tenotomy for treatment of common extensor tendinosis in the elbow. J Ultrasound Med. 2006 Oct;25(10):1281-9. doi: 10.7863/jum.2006.25.10.1281. PMID: 16998100.