Distal Bicep Tendon Pain

The front muscle of your upper arm is called the biceps muscle. This muscle attaches to the shoulder via two tendons and is attached to the elbow bone via one tendon. The latter tendon is also called the distal biceps tendon. Pain in distal bicep tendon is not uncommon. It is mainly due to tendinitis and rupture of the tendon.

Pain Caused by Bicep Tendon Tendinitis


The symptoms of distal bicep tendon pain are due to inflammation which may be caused by any of the following:

  • Ÿ   Tendon strain due to a sudden increase in intensity or amount of activity.
  • Ÿ   A direct blow/injury to your elbow, which is not common.
  • Ÿ   Overuse/repetitive bending of the elbow or rotation of the wrist.


1.   R.I.C.E. Method

The initial treatment for pain and inflammation in the first 3 days consists of the R.I.C.E. method. This means rest (R), ice application (I), compression with a bandage (C), and elevation of the affected limb (E). Aside from these, anti-inflammatory medications may be used if pain and inflammation are not relieved.

2.   Physiotherapy

This form of treatment promotes rapid healing, ensures optimal outcome, and reduces the risk of recurrence of distal bicep tendon pain. It may include any of these:

  • Massage
  • Ultrasound/electrotherapy
  • Joint mobilization
  • Stretches
  • Ice/heat treatment
  • Strengthening exercises
  • Education
  • Anti-inflammatory treatment
  • Advice on activity modification
  • Gradual return to activity

3.   Other Treatments

If your pain does not improve even after appropriate physiotherapy, further investigation may be needed, which may include X-ray, ultrasound, MRI/CT scan, medical intervention, corticosteroid injection, and referral to the specialists.

4.   Surgery

Surgery for tendinitis is rarely needed, especially if there is evidence of gradual improvement. However, occasionally it may be indicated if conservative management for six months fails. Acromioplasty and anterior acromionectomy are the standard procedures for bicipital tendinitis. 


Recovery from distal bicep tendon pain due to tendinitis may occur within six weeks with conservative treatment, although this may vary considerably depending on the severity of injury, hand dominance, and your activity level.

Most people resume their usual activities within two weeks after surgery. However, you must avoid lifting or carrying heavy objects during this period. Strengthening begins after three months. Your ability to return to previous activity levels depends on various factors, but it is often within three to six months.

Pain Caused by Distal Biceps Tendon Rupture


Rupture of the distal biceps often occurs when you lift a heavy item with your elbows bent. Usually, it is because the load is heavier than you have expected, or the object being carried shifts unexpectedly during lifting. Your biceps muscle contracts very hard to be able to handle the heavy load, and as muscle tension increases, the distal tendon tears or snaps where it is connected to the radius.


1.   Self-Care

Your doctor may advise you to rest your elbow and modify your activities to help reduce swelling and distal bicep tendon pain. Non-steroidal anti-inflammatory medications like ibuprofen may be prescribed to relieve pain. Although these will help you bend your elbow, you will experience a decrease in ability to twist your elbow and surgery is most often prescribed within several days after the injury.

2.   Surgery

Surgery aims to reattach the biceps tendon to the radial bone in patients who sustain a full tear of their distal biceps tendon.

3.   Splinting

Certified therapists can design custom-fit splints for your joint to act as a brace to support the elbow and limit stress during activity. You may also use a sling for additional support.

4.   Hand and Elbow Therapy

Certified therapists often work closely with your doctors to customize therapy and your rehabilitation program in order to restore function to your elbow. They provide patients with exercises and materials to maximize elbow function recovery.


Immediately after your surgery, the surgeon may place a cast around your elbow which may stay for up to 6 weeks. Some surgeons use a special brace to allow a range-of-motion for your elbow within 1-2 weeks. At the start of your therapy, you may need ice application and electrical stimulation to help control swelling and pain from surgery. The therapist may also apply massage and other hands-on treatments to relieve muscle spasms and pain.

You will also gradually start to do exercises to improve movement in your shoulder, forearm, and elbow. However, you need to avoid doing too much exercise too quickly. Exercises involving the biceps muscle should be avoided until after at least 4-6 weeks after surgery. You may begin with some light isometric muscle strengthening exercises that work your biceps muscle without straining the tendon.

After six weeks, you can start doing active strengthening exercises. Your therapist will coach you about exercises to help strengthen and stabilize the arm muscles and joints, without putting too much stress. You may need therapy for 2-3 months, but it may take 4-6 months to be able to safely begin forceful biceps activities.

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