T Nation

Distal Bicep Tendon Rupture


Short story, I ruptured my non-dominant-arm distal bicep tendon in late October. Due to some insurance holdups and occupational demands, surgery got scheduled for 6-weeks post injury, which is late, but doable, according to my surgeon.

In the six weeks, after initial trauma healed, I discovered it wasn’t much of a hinderance to anything except traditional palm-up bicep curls (which I could do, but with much less weight) and how my left arm looked in a t-shirt.

So … I opted out of surgery. Having been down that road with a dominant-side rotator cuff, I chose to eat the slightly diminished function and aesthetics as part of aging.

Right now, my workouts are back to damn near normal. Palm up curls are a weakness (down 40 pounds for sets of 12 with EZ-curl bar) but still doable. I feel strong as ever in every other areas, and have focused on strengthening braichailis and forearms 5x per week, and am hopeful I can start putting some mass back on my left arm in supporting areas.

I’ve seen zero accounts online of dudes who are fitness addicted neglecting surgery of this, and it’s no mystery why – doctors don’t recommend it and it’s a severe hit to one’s vanity.

That said, I’m wondering if there’s anyone in here with a success story involving non-surgical treatment of a full rupture of a distal bicep tendon. Would love some support down the path, because the window has passed for revision. Can’t say I don’t have regrets every day, but I feel good and didn’t have to have my left thumb up my ass for six months waiting for the tendon to heal – she gone!

Anyway, any constructive advice would be much appreciated!

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Had mine repaired 2 weeks post injury. What do you qualify as “success story”? Truthfully, and I think you expect to hear this, nothing will get any better for you than it is now. The bicep cannot contract so you literally are not working it all when curling, other muscles are taking over. Without contraction the muscle will not grow and I suspect it would continue to atrophy but I am far from a medical professional.

Yeah, good point on ‘success story.’ How about, ‘let me know how it went for you and what you did along the way, regrets, positives, negatives.’

It’s interesting. I don’t know the anatomy, but I do have a bicep muscle and it does contract, it’s just in a higher position and lacks the bottom belly. It’s small but hard as a rock and responds to lifts with a pump, so I’m confused by the whole matter. Doc mentioned bicep would ‘scar into place’ and find a new attachment point.

You also may not have had a total rupture, so there’s a good chance your bicep is “hanging by a thread” as it were

I completely ruptured my distal biceps tendon in my non dominant arm doing Brazilian jiu-jitsu 1 year ago and I never had it repaired. After meeting with the surgeon and going over the pros and cons of doing the surgery, I decided to not repair it due to the risk (albeit small) of nerve damage in my arm that could result in permanent numbness in my hand. Since I am a dentist and need both hands to do my job, I decided I couldn’t accept this risk to my livelihood. The surgeon showed me a summary of the scientific literature on the outcomes in terms of strength and function in a nonrepaired biceps tendon rupture. It showed a 30% loss of strength in flexion and a 50% loss of strength in supination and pronation.

I took the same approach as you and decided to work the shit out of that brachialis and brachioradialis. At first after the injury it was hard to do a single chin up. Now I am back to doing the same number as before the rupture. I can confidently report no loss of flexion strength in my left arm compared to my right one. However, I do notice a somewhat weaker function in pronation and supination as compared to my right arm. In terms of appearance, my upper arm measurement is exactly the same as it was preinjury. My biceps has definitely atrophied (although surprisingly little), but my other upper arm muscles have grown enough to compensate.

I agree with you that there is very little information out there from a strength and fitness perspective on outcomes for people who have not had the repair done. Overall I am pleasantly surprised by my function and appearance of the arm at the one year mark. I really do think that for you it will depend on how determined you are to compensate for the loss of the biceps by working on the other upper arm musculature. Don’t be scared by the seeming lack of others out there who have chosen the non repair route. If you use the injury as motivation to come back bigger and stronger than you will do just that. Good luck! I’d be happy to answer any other questions you have about this. Us one-tendon dudes gotta stick together!


That was my first line of questioning, being paranoid of another event that felt like getting shot with a .22 in the arm. Doc and MRI confirm, full rupture, no threads.

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Thank you for the reply. You pretty much confirmed my gut instinct after a couple months of training – the deficit of strength is rapidly dissipating, and even back to doing pullups – and high hopes of returning to near 100%. Funny, I’ve also found a new level of motivation in training to overcome this little bump in the road. The info is much appreciated, and will be in touch!

The one other thing I would add is to use a neutral grip (ie. palms facing each other) as much as possible when working that arm. Whether it be chins, curls or whatever. This helps to put the brachialis into a much more favourable orientation as opposed to a palm up or a palm down grip. It helps you get the most force production from it while putting it in the least likely position to be injured itself.


Thanks. It is very interesting I’ve lost almost zero strength on hammer curls and neutral-grip pullups. Sticking with that approach for the foreseeable future.

Here another one-tendon dude! I ruptured my left (non-dominant arm) distal bicep tendon six weeks ago. I also chose not to have surgery. Well, chose… I had chemo threatment 9 years ago and that already damaged my veins a bit.

Also being a self-employeed ICT guy which needs both his hands made me decide not to have the surgery. That was a tough decision… I researched all the internet for stories like yours. Just searching for some positive news, because I was quite devastated about it. That’s also the reason I found this recent post.

I have trained all my life, on and off, but always enjoyed doing it. So this was not the best moment in my life. It happened by the way, when I wanted to lift a door which I was going to paint. I wasn’t even doing an insanely heavy dumbell curl, damn it! :smile:, there goes a cool story.

I recently sent an email to a German guy which had 2 tendon ruptures, one fixed, the other not. And he is still in a great shape and does not feel much difference. That gives me hope.

Your stories also give me hope that things will get better and I am also already working out to get the most out of it.

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Ha! I busted mine while moving a trailer in the driveway, so no cool story here either. I partially tore my right one a couple years ago while … bowling. And I don’t bowl. But that thing was a massive pain in the ass to get healed.

Mine’s progressing by the week. By 8 weeks it was not noticeable in everyday life. Optimistic the aesthetics will improve by doing the work. Good luck, and post updates.

I just read your post about your partially torn bicep. Bowling is already on my list of activities to never do again, I can live with that. I’m no bowling guy either, hahaha.

I’m in week 6 now, and yes every day tasks are pretty doable now. But that is not what I aim for, I want more. I haven’t done hammercurls or (assisted) neutral-grip pullups, but I will try them out!

You said in your first post that doctors don’t recommend it, but here in The Netherlands they will not opt for surgery immediately and let you know the pros and cons of the surgery.

Here an interview of 2 doctors discussing the pros and cons of surgery which I found: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5213928/

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Thanks – I came across that page when I was trying to make the choice, and it further swayed me to skip getting sliced and diced.

You get an MRI that confirmed full rupture? My partially torn tendon was much more problematic. Took months of starts and restarts because I kept inflaming the scar tissue and so forth. Finally made progress by laying off it for six weeks completely, doing rehab exercises every day and injecting BPC-157 in tandem. Thing now feels bulletproof and is even devoid of tendonitis, which I suffered from for a long time.

Not having a tendon at all, the pain is zero at this stage. Just working to bring the strength back. I’d say it is 75% of my right arm, which is pretty damn impressive to me. Stay the course and Godspeed!

Hey @dutch_guy!! Welcome to the site! I was pretty devastated too when I first ruptured my tendon as I thought my lifting career and athletic pursuits were done. The thing that really helped me come to terms with it was a long discussion I had with the orthopaedic surgeon I saw. He was a former university football player and a very physically impressive/strong guy. He completely reassured me that I would be able to regain full strength and function in that arm without the surgery. The fact that he was a lifter and athlete himself made me trust what he was saying. I was very lucky to get referred to him. Anyways, be diligent and consistent in your training of your arm and I’m sure you will be very happy with your decision in the long run. Just be careful not to over stress it too fast as you don’t want to tear anything else in there. Slow and steady wins the race.

Thanks guys! How about normal dumbell curls? Are you able to do these with a decent amount of weight? At this moment they are very disappointing for me in terms of weight.

I’m not trying to lift anything heavy, and changed my routine completely with higher reps and much lower weights. But a maximum of 4kg dumbell curl with my Popeye arm, damn…

And how about lifting normal every day stuff, like lifting a heavy box? Are you able to do it?

Supinated grip curls are no problem for me now. I’d say my injured arm is about the same as my non-injured arm now or at least as strong as it was before injuring it. As far as everyday life goes, I’d say I don’t really notice any impairment in my activities or having to adjust the way I do things to accommodate the injured arm. If I have been impaired in any way, it’s been so slight that I haven’t really noticed it. Again, use this as motivation to build the strength in your arm to a level that’s greater than what it was with a fully functioning biceps. It definitely can be done.

Sorry for the delay. Been off-grid for a bit. Been further investigating, and saw that Louie Simmons from Westside Barbell has ruptured both of his bicep tendons and didn’t fix them, along with some of his proteges at that joint, and a google search will yield some interesting results there. Louie is a maniac, but his credentials speak for themselves. So does the strength of the individuals he trains.

To your questions and comments. Let your trauma heal. May take another month. Start very light/high reps with curls. You’ll see you can do them all, but strength will vary. Hammer curls, supinated, like CMdad said, are the easiest go, but you will be able to work your way up. My research says you can hope to achieve 70% of your original strength over time. I’d say I’m damn close to that now, being about 14 weeks post-injury.

I don’t notice mine at all in everyday activities or at the gym unless I’m doing bicep curls. Ranch work on the weekends either. Fifty pound feed sacks with one arm, hanging critters in the walk-in cooler. Things will get better. Stay the course. Do the work.

I used daily pronation, supination, flexion and extension exercises, along with BPC-157 to heal my partial tear in my right arm, and am planning to hit that approach hard on my ruptured side to strengthen all surrounding muscles and aid in the rest of the healing. The arm looks better by the week, and am optimistic it’ll be a minor aesthetic imbalance in a few more months.

Keep us posted. And Godspeed.

Thanks guys, these are all the right things one wants to hear! Will keep you posted how things come along. Thanks!

Tore mine yesterday via armbar.

I have full flexion. Little pain that’s localized. Can flex it with only mild discomfort. Only rolled up an inch or so. But a Dr. I saw said he thinks it’s a full rupture. Wtf… I hope not. I don’t want surgery

That’s exactly how I tore mine! It’s a shitty situation but it can be dealt with. Whatever option you choose (ie. surgery or non-surgery), just remember that nobody cares more about your health than you do. You have to be your own advocate when you are negotiating the healthcare system. Try to find a good sports medicine doctor and a surgeon who deals with athletes. Get some good advice and good luck! Whatever treatment you choose, work hard and come back stronger than ever!