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Surgical repair of the distal biceps tendon rupture can be a challenge, especially when patients present with a retracted tendon. The tendon stump is often difficult to find and retrieve. In this aticle, we described a technique using ultrasound imaging at the start of the procedure. Under ultrasound guidance, a breast biopsy needle is used to help localize and mark the retracted tendon edge as well as the distal rupture site. Ultrasound is also used to mark important neurovascular structures at risk to help speed up exposure and avoid complications.