30/03/2026
Last year I was confronted with an extremely rare injury - only a few cases reported in medical literature! A friend of mine was moving a heavy bed and injured both arms - sustaining BILATERAL distal biceps tendon ruptures 🤯. These injuries are fairly common, but to injure both arms at the same time is exceedingly rare.
The tendon pulls off the bone in the forearm (radius) and the biceps muscle becomes shortened, and looks like a ball especially when contracted - this gives the appearance of “Popeye” arms. In healthy, active people repair is usually recommended as this injury results in weakness of flexion and more importantly supination (a twisting movement e.g. using a screwdriver, turning a doorknob etc.).
One of the biggest problems with a distal biceps tendon tear is delayed or missed diagnosis as surgery to repair the tear must be done within 4 weeks for the best results - after 6 weeks a repair may not be possible. Fortunately he saw me within hours of the injury and the surgery could be scheduled for the following day.
Another issue is the post-op protocol - the arm is splinted for the first 10 days and can’t be used for much - so fixing both arms at the same time would make life miserable for my friend and his spouse 👀. I decided to stage the procedures - the right arm was fixed first, and ten days later the splint was removed and exchanged for an elbow ROM brace which allowed for initiation of movement. A few days later the left arm was fixed in the same manner. The ROM braces were worn on both arms for six weeks in total, allowing a gradual increase in movement.
With time his flexion and supination power will be restored. In addition the “Popeye” arms are now gone and his normal biceps contour has been restored. The surgery is not typically done with the main aim of improving cosmesis, although it should be noted that this injury often occurs in body builders, for whom restoration of a normal biceps contour is extremely important. 💪🏻💪🏻
