From the Guidelines
The distal biceps tendon is the most commonly torn tendon in the forearm during weightlifting activities. This tendon attaches the biceps muscle to the radius bone in the forearm and can rupture when excessive force is applied, particularly during eccentric loading such as lowering a heavy weight during bicep curls or catching a heavy object 1. The injury typically occurs when the elbow is flexed at approximately 90 degrees and suddenly forced into extension while the biceps muscle is contracting. People often describe hearing or feeling a "pop" followed by pain, swelling, and weakness in the elbow. Risk factors include being male, over 30 years old, smoking, and using anabolic steroids. The injury can be partial or complete, with complete tears often requiring surgical repair, especially in active individuals who need full strength and endurance. Without surgery, the arm may lose up to 30% of its supination strength (ability to rotate the palm upward) and 15% of its flexion strength. Early medical evaluation is important for proper diagnosis and treatment planning.
Some key points to consider when evaluating tendon injuries in the forearm include:
- The use of MRI in the assessment of tendon injuries, particularly for the diagnosis of partial tears and tendinopathy 1
- The importance of relative rest and eccentric strengthening exercises in the treatment of overuse tendinopathies 1
- The potential benefits and limitations of ultrasonography and magnetic resonance imaging in the diagnosis of tendon injuries 1
- The need for careful consideration of the risks and benefits of surgical repair, particularly in active individuals who require full strength and endurance 1
Overall, the diagnosis and treatment of tendon injuries in the forearm require a comprehensive approach that takes into account the individual's medical history, physical examination findings, and imaging results. Early medical evaluation and proper treatment planning are essential to minimize morbidity, mortality, and improve quality of life.
From the Research
Tendon Injury in the Forearm
The tendon in the forearm that could be torn while lifting weights is the distal biceps tendon.
- This type of injury is relatively rare and most commonly occurs in middle-aged men after a sudden, forced eccentric contraction of the flexed elbow 2, 3, 4, 5, 6.
- The distal biceps tendon plays a crucial role in forearm supination and elbow flexion, and its rupture can result in functional deficits 3, 5, 6.
Risk Factors and Mechanisms
- The risk factors and mechanisms of distal biceps tendon tears include sudden, forced eccentric contraction of the flexed elbow, and high clinical suspicion and routine physical examination are essential for proper and timely diagnosis 2.
- The treatment for distal biceps tendon tears depends on the extent and timing of the injury, and options include nonoperative management, repair, and reconstruction with or without repair of the bicipital aponeurosis 2, 3, 4, 5.
Treatment Options
- Operative management is associated with superior elbow and forearm strength and endurance, as well as superior patient-reported outcomes, compared to nonoperative management 6.
- Various fixation techniques, including bone tunnels, cortical buttons, suture anchors, interference screws, or a combination, seem to provide different fixation strength but similar clinical outcomes 3, 5.