Surgical Anatomy of the Distal Biceps Tendon

  • Deepak N. Bhatia
  • Gregory Bain


The distal biceps tendon (DBT) anatomy is complex, and its structural and insertional morphology has surgical implications. The DBT has long and short tendon components, and these show three variable insertional footprints into the radial tuberosity. The DBT insertion passes through the proximal radioulnar space (RUS) during dynamic rotation, and an alteration in RUS or DBT dimensions may predispose to impingement and wear. The DBT is closely related to neurovascular structures of the cubital fossa, and these structures are potentially at risk during open and endoscopic surgery. Detailed knowledge of the structural, insertional, and neurovascular anatomy of the DBT is necessary to safely replicate DBT kinematics during repair and reconstructive surgery for distal biceps pathology.


Distal biceps tendon Radioulnar space Radial tuberosity Parabiceps portal Biceps endoscopy 



Conflict of Interest

Each author certifies that he has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. The author retains the copyright to the images, videos, and content in this chapter.


  1. 1.
    Bhatia DN, Kandhari V, DasGupta B. Cadaveric study of insertional anatomy of distal biceps tendon and its relationship to the dynamic proximal radioulnar space. J Hand Surg Am. 2017;42(1):e15e–e23.CrossRefGoogle Scholar
  2. 2.
    Bhatia DN. Endoscopic distal biceps repair: endoscopic anatomy and dual-anchor repair using a proximal anterolateral “parabiceps portal”. Arthrosc Tech. 2015;4:e785–93. Scholar
  3. 3.
    Bhatia DN. Endoscopic repair of acute and chronic retracted distal biceps ruptures. J Hand Surg Am. 2016;41(12):e501–7. Scholar
  4. 4.
    Phadnis J, Bain G. Endoscopic-assisted distal biceps footprint repair. Tech Hand Up Extrem Surg. 2015;19:55–9.CrossRefGoogle Scholar
  5. 5.
    Eames MJ, Bain GI. Distal biceps tendon endoscopy and anterior elbow arthroscopy portal. Tech Shoulder Elbow Surg. 2006;7:139–42.CrossRefGoogle Scholar
  6. 6.
    Bhatia DN, DasGupta B, Panjwani T. Cadaveric study of anterior and posterior elbow endoscopy portals for endoscopic distal biceps repair: comparative anatomy-at-risk. Surg Radiol Anat. 2016;38(7):781–91. Epub 2016 Feb 9CrossRefGoogle Scholar
  7. 7.
    Mazzocca AD, Cohen M, Berkson E, et al. The anatomy of the bicipital tuberosity and distal biceps tendon. J Shoulder Elb Surg. 2007;16(1):122–7.CrossRefGoogle Scholar
  8. 8.
    Hutchinson HL, Gloystein D, Gillespie M. Distal biceps tendon insertion: an anatomic study. J Shoulder Elb Surg. 2008;17(2):342–6.CrossRefGoogle Scholar
  9. 9.
    Eames MH, Bain GI, Fogg QA, et al. Distal biceps tendon anatomy: a cadaveric study. J Bone Joint Surg Am. 2007;89(5):1044–9.Google Scholar
  10. 10.
    Zeltser DW, Strauch RJ. Vascular anatomy relevant to distal biceps tendon repair. J Shoulder Elb Surg. 2016;25:283–8. Scholar
  11. 11.
    Honma S, Tokiyoshi A, Kawai K, Koizumi M, Kodama K. Radial artery running beneath the biceps tendon and its interrelation between the radial recurrent arteries. Anat Sci Int. 2008;83(4):232–8.CrossRefGoogle Scholar

Copyright information

© ISAKOS 2020

Authors and Affiliations

  • Deepak N. Bhatia
    • 1
    • 2
  • Gregory Bain
    • 3
  1. 1.Sportsmed MumbaiMumbaiIndia
  2. 2.Department of Orthopaedic SurgerySeth GS Medical College and King Edward VII Memorial HospitalMumbaiIndia
  3. 3.Department of Orthopaedic SurgeryFlinders University and Flinders Medical CentreAdelaideAustralia

Personalised recommendations