The ruptures of the distal biceps tendon are classified according to the severity and type of injury:

1. Partial rupture: Only part of the tendon is affected, often with milder symptoms.
2. Complete rupture: The tendon is completely torn, leading to a significant loss of function.
3. Traumatic rupture: Acute injury due to sudden trauma, such as a strong tensile load.
4. Degenerative rupture: Chronic damage due to age-related wear or repeated overuse.
5. Avulsion injury: The tendon tears off at the attachment from the radial bone, often accompanied by a bony detachment.

The main causes of a distal biceps tendon rupture are acute stress and chronic pre-damage:

- Acute causes:

- Sudden, strong tensile stress on the biceps, for example when lifting heavy loads or catching a fall.

- Accidents or injuries during sports activities.

- Chronic causes:

- Degenerative changes due to aging that weaken the tendon.

- Repeated overuse of the biceps tendon, especially during physical work or sports activities.

- Risk factors:

- Smoking, which impairs blood circulation and healing of tendon tissue.

- Anabolic steroids or other medications that can reduce tendon strength.

The symptoms vary depending on the severity of the injury, but typically include:

- **Sudden pain:** A sharp pain at the front of the elbow, often accompanied by an audible "pop."

- **Swelling:** Local swelling in the area of the elbow immediately after the injury.

- **Loss of strength:** Significant weakness in bending and rotating movements of the forearm, especially in supination (turning the palms upward).

- **Altered muscle contour:** The biceps muscle may shift upwards, referred to as a "Popeye deformity."

- **Tenderness:** Pain when touching or making slight movements of the elbow.

- **Movement restrictions:** Limitations in everyday movements such as turning a screw cap or carrying objects.

The diagnosis is made through a combination of medical history, clinical examination, and imaging techniques:

- Medical History:

- The doctor inquires about the accident, symptoms, and any possible pre-existing conditions.

- Physical Examination:

- Checking arm mobility, strength, and typical deformities.

- Special tests like the hook test, which checks if the tendon is palpable.

- Imaging:

- Ultrasound: Visualization of tendon injuries and fluid accumulations.

- MRI: Detailed imaging of the tendon and surrounding structures to confirm the diagnosis.

- X-ray: Exclusion of accompanying bone injuries, especially in avulsion injuries.

Conservative Therapy

For partial tears or minor symptoms, non-operative treatment may be sufficient:

• Immobilization: Use of a splint or brace to relieve the arm.
• Medication Therapy:
  • NSAIDs: For pain relief and reduction of inflammation.
• Physical Therapy:
  • Targeted exercises to restore mobility and strengthen the muscles.
  • Promotion of supination and flexion through controlled training.
• Pain Management:
  • Application of cold or heat therapy to support healing.

Surgical Therapy

For complete tears or persistent limitations, surgery is required:

• Tendon Refixation: Reattachment of the tendon to the radial bone, often using anchors or screws.
• Minimally Invasive Techniques: Arthroscopic procedures for quick rehabilitation and minimal tissue damage.
• Reconstruction: In chronic tears, when the tendon can no longer be directly fixed, a tendon transfer is often performed.

To prevent ruptures and maintain tendon health, the following measures are advisable:

1. Strengthening the muscles: Building strong and flexible arm muscles through regular training.
2. Avoiding overload: Protecting the tendon during repeated heavy loads.
3. Proper technique: Correct movement sequences during sports activities and heavy physical work.
4. Warming up before exertion: Preparing the muscles and tendons for intense training.
5. Regular check-ups: Early detection of pre-damage or symptoms of overload.