METHODS: A healthy 38-year-old male presented to his primary care physician complaining of right elbow pain that started while lifting an all-terrain vehicle into a truck. On physical examination, the patient had obvious deformity of the distal upper arm, as well as a positive squeeze test. Magnetic resonance imaging confirmed the presence of complete rupture of the distal biceps brachii tendon and the patient was referred to orthopedic surgery for evaluation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Prompt diagnosis and referral to orthopedic surgery optimizes outcomes and minimizes complications after distal biceps brachii tendon rupture. Oftentimes, gross examination shows obvious deformity of the distal upper arm, but when swelling, mobility limitations, or patient anatomy hinder this physical examination finding, the diagnosis can be missed. Knowledgeable emergency physicians can perform a physical examination and other diagnostic tests that can confirm or rule out a diagnosis in order to achieve the best outcomes for patients.