Biceps Injury

What Is The Distal Biceps Tendon?

The biceps muscle of the upper arm is probably one of the most famous muscles in the body. It is located at the front of the upper arm bone (humerus). It is formed from two muscle bellies or heads (hence the name "bi-ceps" - two heads) that have distinct attachments at the shoulder.

At the other end of the muscle, near the elbow, the two heads join to form a single distal biceps tendon that inserts into the radius bone, one of the two forearm bones. Through this distal attachment the biceps participates in both elbow flexion (bending) and supination (turning the forearm from a palm-down to a palm-up position) such as when turning the pages of a book, wringing out a towel or tightening a screw with a screwdriver.

What Is Distal Biceps Tendonitis?

Distal biceps tendonitis refers to pain associated with the tendon caused by swelling, micro-tears in the tendon, or inflammation of the sheath around it. It is commonly caused by overuse or repetitive activities that place strain on the biceps muscle. It can also be caused by poor technique when performing routine movements involving the elbow joint that you may already be accustomed to.

Distal biceps tendonitis is associated with the following sports:

• Gymnastics
• Weightlifting
• Bowling
• Tennis
• Golf

Symptoms Of Distal Biceps Tendonitis?

Common symptoms you may experience if you have distal biceps tendonitis include:

• Stiffness and elbow pain that may extend up to the lower end of the biceps or down into the forearm. In most cases, the pain will come on gradually and worsen over time.
• Dull pain that gets worse when bending the elbow against resistance, such as when doing a chin-up, or twisting the arm like when trying to open a jar.
• Swelling at the front of the elbow may occur. In some cases, patients may experience creaking or popping (crepitus) in the forearm when they bend their elbow or twist their forearm.

Diagnosing Distal Biceps Tendonitis?

A careful history of your symptoms and a physical examination will give a strong indication as to what the diagnosis is.  Confirmation of the diagnosis is made with an ultrasound scan or magnetic resonance imaging (MRI) that would also to help rule out any underlying condition that may need addressing.

Other Painful Conditions Of The Distal Biceps?

A partial or complete tear of the distal biceps tendon will cause pain in a similar area. These are typically associated with trauma (a strong-arm tackle in rugby) or a maximal load effort lifting a weight. The onset of pain is usually acute/sudden and, in the case of a complete tear, may be associated with deformity of the biceps muscle.

Although the biceps muscle looks great when you flex your elbow it only accounts for 30% of flexion strength. The biceps is more important for supination accounting for roughly 60% of this function so a complete rupture of the distal tendon can result in a functional weakness that may be significant depending on what you want to get back to doing.

If you think you have a distal biceps tendon rupture you should arrange to see a doctor as soon as possible as you may require surgical reconstruction.

How Do You Treat Distal Biceps Tendonitis?

Most cases of distal biceps tendonitis will settle with time and conservative treatment if treated early.

• Initial management involves activity modification, such as avoiding actions that make the pain worse, applying cold packs and using nonsteroidal anti-inflammatory medication (NSAIDs), if appropriate.
• Physical therapy is routinely recommended during which stretching and strengthening exercises are prescribed.
• Platelet-Rich-Plasma (PRP) injection - You may be recommended to have an injection of PRP around your distal biceps tendon to encourage healing of the tendon. To learn more about PRP click here.
• Corticosteroid injection - Steroid or cortisone injection is reserved as a last resort before surgery as it can weaken the tendon risking rupture.
• Surgery - Cases that do not respond to non-operative treatments may be referred for key-hole surgery to look at the attachment of the tendon to the bone (distal biceps bursoscopy) to see if there is a tear that is stopping your symptoms from settling.

If you are experiencing pain around your elbow get in touch to find out how we can help.