Why does it occur?

The biceps is a muscle located at the front of the upper arm spanning from the shoulder to the elbow.  The biceps muscle transitions to a tendon near the elbow. This tendon then attaches to the Radius bone.  Most people mistakenly think the Bicep’s main function is to flex the elbow, however, the main function of the Biceps is actually to supinate the forearm (rotate the forearm so that the palm faces upward).  The Brachialis muscle is actually the main flexor of the elbow, while the Biceps muscle secondarily helps this action as well. Given this function, the biceps tendon is subject to overuse and can easily become inflamed, which is known as tendonitis.  Over time, if left untreated, this can progress into partial and eventually full tears of the tendon. Common overuse activities that can lead to tendonitis are those that involve gripping, lifting and supination activities such as use of a screwdriver.

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Symptoms

The most common symptom is pain around the front of the elbow.  This pain is usually worsened with gripping, lifting and especially supination.  Patients may also experience weakness as well. It is important to note that if a sudden pop is felt in your elbow, you may have ruptured your distal biceps tendon.  Dr. Lee would need to see you immediately as surgery for a distal biceps rupture needs to be completed as soon as possible. Read more about Distal Biceps Ruptures here. 

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Diagnostic Testing

Distal biceps tendonitis is usually diagnosed using clinical information gathered from the history and physical examination.  An x-ray will often be ordered to rule out possible fracture and any other underlying bone pathology. An MRI may be ordered to further evaluate the tendon itself, especially if a distal biceps partial tear or rupture is suspected.

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Treatment Considerations

Distal biceps tendonitis is initially treated nonoperatively.  Any activities that cause pain should be avoided. Physical therapy is an important part of nonoperative treatment and is usually prescribed.  NSAIDs such as Advil or Aleve (if not contraindicated for the patient) may be considered to decrease pain and swelling. Platelet-Rich Plasma (PRP) is another excellent treatment option.  More information on PRP can be found here.  Dr. Steven Lee was one of the first physicians in NYC to utilize PRP in the upper extremity, has been a leader in treating this disorder with PRP, and regularly gives lectures on the subject.  He arguably has more experience with PRP in the upper extremity than any other orthopedic surgeon in NYC, and has successfully treated countless numbers of patients with this modality.

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*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice.  Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.

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*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.

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