Distal Biceps Tendinopathy
What is the distal biceps tendon?
The biceps muscle goes from the shoulder to the elbow on the front of the upper arm. Tendons attach muscles to bone. Two separate tendons connect the upper part of the biceps muscle to the shoulder. One tendon connects the lower end of the biceps to the elbow.
The lower biceps tendon is called the distal biceps tendon. The word distal means that the tendon is further down the arm. The upper two tendons of the biceps are called the proximal biceps tendons because they are closer to the top of the arm. Distal Biceps Tendinopathy
The distal biceps tendon attaches to a small bump on the radius bone of the forearm. This small bony bump is called radial tuberosity. The radius is the smaller bones between the elbow and the wrist that make up the forearm. The radius goes from the outside edge of the elbow to the thumb side of the wrist. It parallels the larger bone of the forearm, the ulna. The ulna goes from the inside edge of the elbow to the wrist.
What is Distal Biceps Tendinopathy?
This degeneration of the tendon attaches the biceps muscle of the upper arm to the radius bone of the forearm. This typically causes pain in the front of the elbow that may be made worse by lifting or twisting motions of the forearm below the elbow.
How is the diagnosis of Distal Biceps Tendinopathy made?
This degeneration of the tendon attaches the biceps muscle of the upper arm to the radius bone of the forearm. This typically causes pain in the front of the elbow that may be made worse by lifting or twisting motions of the forearm below the elbow.
How is the diagnosis of Distal Biceps Tendinopathy made?
The diagnosis can be made after a careful history and physical examination. In most cases the pain will come on gradually and will increase with time. The pain will be felt at the front of the elbow. The pain may be made worse by lifting or twisting motions. Swelling of the front of the elbow may occur. Pressing on the tendon will typically cause pain.
An ultrasound scan or magnetic resonance imaging (MRI) scan may help to make the diagnosis when there is doubt.
Heavy pulling exercises such as biceps curls or pull-ups on a bar can put too much stress on the biceps tendon. This leads to swelling of the tendon known as distal bicep tendonitis.
Common symptoms of distal bicep tendonitis include:
⦁ sharp pain or a dull ache at the front of the elbow or just below the elbow
⦁ pain and weakness after pulling exercises or repeated manual work
⦁ tender spots in the elbow just below the biceps
Distal bicep tendonitis is different from tennis elbow or Golfer’s elbow. These other tendon injuries occur on the inside and outside of the elbow. Often, it can be difficult to tell the difference between these tendon injuries. This is where ultrasound or MRI may help put you on the path to the right diagnosis and treatment.
Can you rupture your distal biceps tendon?
Yes, but it is uncommon. Complete ruptures occur after trauma, such as a tackle during contact sports. Often, players report a pop or crack followed by severe pain and weakness.
How do we treat distal bicep tendonitis?
Overall, most cases of distal bicep tendonitis will settle with simple treatments. A short course of anti-inflammatories such as ibuprofen/ Naproxen will help with the pain.
The first line of treatment that will be successful in intreating most cases is the modification of activities, rest and physiotherapy with stretching and eccentric loading exercises.
It is essential to change or modify your gym exercises. For example, changing from biceps curls to hammer curls or from pull-ups to lat pulldowns usually helps. Also, changing the wrist grip for pulling exercises from palm down to palm up is often better. Strengthening the biceps muscle starting at a lighter weight and increasing slowly and progressively aids in pain relief.
Although cortisone is a powerful anti-inflammatory, we need to be careful when using cortisone for the distal biceps tendon. There is evidence that cortisone injections weaken tendons leading to rupture. Thus we do not recommend injecting steroids.
A less risky and potentially more practical option is an injection called ‘needle tenotomy’. Using a numbing solution, we pass a small needle through the biceps tendon multiple times. We think this needling causes micro-injuries leading to tendon healing and remodelling. If this treatment does not work for you, Prof Imam may suggest an injection with platelet-rich plasma (PRP). In some cases, looking at the tendon’s attachment to the bone using a keyhole technique (distal biceps tendon bursoscopy) may help identify if there is any tearing of the tendon. Prof Imam prefers to do needle tenotomy and PRP injection if the physiotherapy fails to manage the problem.