Treatment for Distal Biceps Tendonitis and Injury Recovery

Distal biceps tendonitis is characterized by inflammation of the distal biceps tendon near its insertion at the radial tuberosity and represents a common cause of anterior elbow pain in adults. The anatomical structure involves the biceps brachii with its two heads (long and short), which insert into the radial tuberosity via the distal tendon, primarily functioning in elbow flexion and forearm supination.

Several risk factors contribute to this condition, including middle-aged male demographics, repetitive lifting activities, eccentric loading of the flexed elbow, weightlifting, manual labor occupations, smoking, and steroid use. Clinical presentation typically includes anterior elbow pain, particularly with resisted elbow flexion and supination, accompanied by weakness in these movements. Pain typically worsens with activity and improves with rest, and patients may present with a visible deformity if a partial or complete tear is present.

Physical examination includes several specific tests such as the Hook test, Speed’s test, and Yergason’s test, along with range of motion assessment, strength testing of elbow flexion and supination, and palpation of the distal biceps tendon. While X-rays are usually normal and primarily used to rule out other pathology, MRI serves as the gold standard for diagnosis, and ultrasound provides useful dynamic assessment.

The differential diagnosis encompasses conditions such as distal biceps tendon rupture, lateral epicondylitis, median nerve entrapment, radiocapitellar pathology, and pronator syndrome. Conservative management typically involves activity modification, NSAIDs, ice therapy, physical therapy, eccentric strengthening exercises, ultrasound therapy, and cautiously administered corticosteroid injections.

Physical therapy focuses on eccentric strengthening, flexibility exercises, manual therapy, activity modification training, ergonomic assessment, and return to activity progression. Surgical management is reserved for cases of failed conservative treatment and is particularly considered in high-demand patients, involving surgical debridement or tendon repair if partial or complete tears are present.

Prevention strategies include proper warm-up before activities, gradual progression of resistance training, proper lifting techniques, workplace ergonomic modifications, and regular stretching programs. Return to activity should be gradual and based on symptoms, beginning with modified activities and progressing through resistance training to sport-specific or work-specific training, with full return permitted when the patient is pain-free with full strength.

The prognosis is generally good with appropriate management, with most patients responding well to conservative treatment. Higher success rates are associated with early intervention, and while return to previous activity level is possible, some patients may require long-term activity modification.