DIstal bicep tendon ruptures most often occur in middle aged men while trying to lift a heavy object. Often a painful “pop” is felt and a deformity of the bicep muscle belly is easily visible. Surgery is indicated for active, healthy individuals who don’t want to lose elbow strength or do not like the deformity. Without surgery, the patient will lose approximately 40% of supination (rotating the palm towards the ceiling with the elbow at the side is called supination) and 30% of elbow flexion strength. Also, without surgery, the patient may have some activity related pain in the bicep region and the persistent visible muscle deformity. Surgery involves reattaching the bicep tendon to the radial tuberosity using strong sutures and a metallic button placed through a drill hole in the bone. The surgery takes about one hour to complete. Post-operatively, a sling is worn for protection for 6 weeks but elbow range of motion is permitted. Physical therapy typically starts at week 6 and is continued for approximately 6 weeks. By four months post-operatively, the tendon is fully healed allowing the patient to return to contact sports and heavy lifting.