Objective: The aim of this research was to evaluate the accuracy of ultrasonogrphy (USG) for differentiating the level of biceps tendon injury and correlate with surgical findings. USG of normal bicep tendon was used as the reference standard. Clinical follow-up was conducted to assess the condition of the biceps. Materials and Methods: The study population included 100 consecutive elbow USG cases with surgical confirmation and 10 cases of a clinically normal biceps tendon in volunteers. The cases were reviewed by two trained radiologists. Bicep tendons were classified as complete tear, partial tear and normal biceps tendon. The posterior acoustic shadowing at the distal biceps tendon was assessed as present or absent. The USG findings were correlated with the surgical findings and clinical follow-up. Result: Ultrasound showed 95% sensitivity, 71% specificity, PPV, NPV and 91% accuracy for the diagnosis of distal biceps tendon tears and level of tearing. Posterior acoustic shadowing on the distal biceps had sensitivity of 97% and accuracy of 91% for indicating complete tear versus partial tear and sensitivity of 97%, specificity of 100%, and accuracy of 98% for indicating complete tear versus normal tendon. Conclusion: Ultrasonography can play an effective role in the diagnosis of elbow injuries when a distal biceps tendon tear is suspected and helps in surgical decision.