One of the more common gym injuries is biceps tendonitis of the elbow. Excessive exercise or overload can lead to swelling of the biceps tendon and distal biceps tendonitis. So, how does pain in the biceps tendon at the elbow present, and what can you do about it?  

What is Biceps Tendonitis Elbow?

The biceps muscle is found at the front of the upper arm. As the muscle passes over the elbow, it forms a strong tendon that attaches to the radius. The biceps muscle has two functions: it bends the elbow and turns the wrist outwards. This muscle is essential for repeated movements, such as biceps curls, manual labour, and screwdriver use.

Overloading the biceps tendon leads to pain and swelling at its attachment to the elbow, a condition often referred to as distal biceps tendonitis.

 

distal biceps tendonitis

How do you Know You have Distal Biceps Tendonitis? 

Heavy pulling exercises, such as biceps curls or pull-ups on a bar, can stress the lower biceps tendon. This stress leads to swelling of the distal biceps tendon, known as distal biceps tendonitis or lower biceps tendon pain.

Common symptoms of lower bicep tendon pain include:

  • Sharp pain or a dull ache at the front of the elbow or just below the elbow, often described as lower bicep tendon pain
  • Pain and weakness after pulling exercises or repeated manual work
  • Tender spots in the elbow just below the biceps

Tennis elbow or bicep tendonitis: How can you tell? 

Biceps tendonitis is different from tennis elbow. Other tendon injuries occur on the inside and outside of the elbow. It can often be challenging to distinguish among these tendon injuries. Generally, careful examination is necessary to determine the cause of elbow pain. Typically, tennis elbow causes pain at the tip of the outside of the elbow, whereas pain from lower biceps tendonitis is more centrally located. This is where ultrasound or MRI may help establish the correct diagnosis and treatment path.

Can you rupture your Distal Biceps Tendon? 

Yes, but it is uncommon to cause a bicep tendon tear at the elbow. Complete ruptures occur after trauma, such as a tackle during rugby. Often, players report a pop or crack followed by severe pain and weakness. The tear occurs at the gym when picking up a heavy barbell with the elbow bent. Typically, the biceps muscle changes shape and resembles ‘Popeye’s biceps.’ Bruising and swelling follow after a few days. Sometimes, the biceps tendon partially ruptures and can mimic lower biceps tendonitis. As treatment changes, recognising abductor tendon tear at the elbow in the setting of tendonitis is essential.

hook test performed on male elbow

Generally, we carefully examine anyone we suspect has a biceps tendon tear at the elbow. The hook test is often used to determine whether the biceps tendon is torn. We use our index finger to hook the biceps tendon near the elbow. The hook test is positive if we can’t feel the tendon over our finger. This means the tendon is torn. 

Distal Bicep Tendonitis Treatment

Overall, most cases of lower biceps tendonitis will resolve with conservative treatment. A short course of anti-inflammatory agents, such as ibuprofen, may help with biceps pain near the elbow. It is essential to change or modify your gym exercises. For example, switching from biceps to hammer curls or pull-ups to lat pulldowns usually helps. Additionally, changing the wrist grip for pulling exercises from palm-down to palm-up is often more effective. Strengthening the biceps muscl by, startingwitht a lighter weight and increasinggraduallyy and progressivel, may reducen lower biceps paif.

What Happens if Exercise Fails for Biceps Tendonitis in the Elbow? 

In complex cases, we consider injections to reduce tendon swelling and stimulate healing. If you get stuck, ultrasound-guided distal biceps tendon injection is an option. Dr Masci has written a scientific paper summarising the use of injections for tendonitis. We can discussseveralw options for distalbicepsp tendonitis with you. First, although cortisone is a potent anti-inflammatory, caution is warranted when using it for the distal biceps tendon. There is evidence that cortisone injections weaken tendons, thereby increasing the risk of rupture. Therefore, we must do cortisone injections with ultrasound to avoid injecting directly into the distal biceps tendon. Moreover, we should prevent injecting cortisone into biceps tendon tears.

Secondly, an injection called’ needle tenotomy’ is a less risky and potentially more practical option. Using a numbing solution, we pass a small needle through the biceps tendon multiple times. We hypothesise that this needling causes micro-injuries that promote tendon healing and remodelling.

Finally, we use platelet-rich plasma (PRP) injections in some cases. PRP is obtained from whole blood taken from a vein in the elbow. We spin the blood in a machine so the cells move to the bottom. The plasma on the top contains smaller cells called platelets, which have growth factors. We inject this plasma into and around the tendon to stimulate healing.

Partial Tear Biceps Tendon: How to Treat It? 

A full-thickness tear of the biceps tendon leads to a significant loss of power and needs surgery. Generally, surgical outcomes are better when surgery is performed within three weeks of injury.

A partial biceps tendon tear is a little more problematic.

Sometimes, a scan describes the tendon as ‘partially torn.’ But in fact, there is a complete tear of one of the heads of the tendon, either the short or long head. In these cases, we recommend a repair. However, some surgeons suggest conservative treatment with rehab and/or injeciton therapy such as PRP injection before considering a repair. In an actual partial tear, the treatment is similar to tendonitis.

Final Word from Sportdoctorlondon about Distal Bicep Tendonitis 

Distal bicep tendonitis is a common cause of elbow pain in gym-goers. Simple treatments can reduce pain and improve mobility. If these simple steps are ineffective, other treatments such as cortisone injections, needle tenotomy, or PRP injections are possible.

Other elbow conditions: