Biceps Tendon Tendinitis, Distal

Biceps Tendon Tendinitis, Distal



Description


Distal biceps tendon tendinitis is characterized by pain at the front of the elbow from inflammation of the biceps tendon, usually from friction at a bony prominence (the bicipital tuberosity). The biceps muscle attaches to bone via three tendons: two at the shoulder and one in the elbow; the biceps is important for bending the elbow and turning the palm up by rotating the wrist. Distal biceps tendon tendinitis is usually an overuse injury, in which symptoms start slowly and gradually get worse.



Common signs and symptoms



• Pain, aching, tenderness, and sometimes warmth or redness over the front of the elbow

• Pain that is worse with elbow bending or wrist rotation (turning the palm up), especially against resistance (lifting or carrying) or with throwing

• Crepitation (a crackling sound) when the tendon or elbow is moved or touched


Causes



• Strain from a sudden increase in the amount or intensity of activity

• A direct blow or injury to the elbow (uncommon)

• Overuse or repetitive elbow bending or wrist rotation, particularly when turning the palm up, or with elbow hyperextension


Factors that increase risk



• Sports that involve contact

• Throwing sports, gymnastics, weight lifting, bodybuilding, and rock climbing

• Heavy labor

• Poor physical conditioning (strength, flexibility)

• Inadequate warm-up before practice or play

• Injury to other structures of the elbow

• Immobilization of the elbow


Preventive measures



• Appropriately warm up and stretch before practice or competition.

• Allow time for adequate rest and recovery between practices and competition.

• Maintain appropriate conditioning that includes elbow flexibility, muscle strength and endurance, and cardiovascular fitness training.

• Use proper technique.


Expected outcome


This condition is usually curable within 6 weeks if treated appropriately with conservative treatment and resting of the affected area.



Possible complications



• Prolonged healing time if not appropriately treated or if not given adequate time to heal

• A chronically inflamed tendon, causing persistent pain with activity that may progress to constant pain and rupture of the tendon

• Recurrence of symptoms, especially if activity is resumed too soon, with overuse, or with poor technique


General treatment considerations


Initial treatment consists of the use of medication and ice to relieve the pain and modification of the activity that initially caused the problem. Later, stretching, strengthening, and building endurance of the elbow muscles in general, and in the biceps muscle specifically, are added. These all can be carried out at home, although referral to a physical therapist or athletic trainer may be recommended. Other treatments, such as ultrasound and


image

Figure 1


From Hislop HJ, Montgomery J: Daniels and Worthingham’s muscle testing: techniques of manual examination, ed 6, Philadelphia, 1995, W.B. Saunders, p 108.


heat, may be utilized by a therapist. An injection of cortisone to the area around the tendon is not recommended, and surgery is rarely necessary or recommended.



Medication



• Nonsteroidal antiinflammatory medications, such as aspirin and ibuprofen, are used to reduce inflammation. Take these as directed by your physician. Contact your physician immediately if any bleeding, stomach upset, or signs of an allergic reaction occur. Other minor pain relievers, such as acetaminophen, may also be used.
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Jul 18, 2016 | Posted by in SPORT MEDICINE | Comments Off on Biceps Tendon Tendinitis, Distal

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