Bicep tendonitis elbow: a common injury in gym-goers

One of the more common gym injuries is bicep tendonitis elbow. Generally, too much exercise or overload leads to swelling of the biceps tendon and distal biceps tendonitis. So how does this injury 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: bends the elbow and turns the wrist outwards. This muscle is essential in repeated movements such as a biceps curl, manual labor, or using a screwdriver.

Overloading the tendon leads to pain and swelling at the biceps tendon attachment to the elbow. It is often called 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 tendon, known as distal bicep tendonitis or lower bicep 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? 

Distal biceps tendonitis is different from tennis elbow. Other tendon injuries occur on the inside and outside of the elbow. Often, it can be difficult to tell the difference between these tendon injuries. Generally, careful examination is necessary to determine the cause of elbow pain. Usually, tennis elbow causes pain at the tip of the outside of the elbow, whereas pain from lower biceps tendonitis is more in the center. This is where ultrasound or MRI may help put you on the path to the correct diagnosis and treatment.

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.

Usually, the biceps muscle changes shape and looks like ‘popeye’s biceps.’ Bruising and swelling follow after a few days. In some cases, the biceps tendon only partially ruptures and can look like lower biceps tendonitis. As treatment changes, it is essential to spot a bicep tendon tear at the elbow from tendonitis.

Generally, we carefully examine anyone we suspect has a biceps tendon tear at elbow. Often, the hook test is used to determine whether the biceps tendon is torn. We use our index finger to try 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 bicep tendonitis will settle with simple treatments. A short course of anti-inflammatories such as ibuprofen will help with biceps pain near the elbow. It is essential to change or modify your gym exercises. For example, changing from biceps curls to hammer curls or from pull-ups to lat pulldowns usually helps. Also, changing the wrist grip for pulling exercises from palm down to palm up is often better. Strengthening the biceps muscle starting at a lighter weight and increasing slowly and progressively aids in lower biceps pain relief.

What happens if exercise fails for biceps tendonitis elbow? 

In complex cases, we consider injections to reduce tendon swelling and stimulate healing. Ultrasound-guided distal biceps tendon injection is an option if you get stuck.

Dr. Masci has written a scientific paper summarising injections for tendonitis. In general, there are a few options for distal bicep tendonitis we can discuss with you.

Firstly, although cortisone is a potent anti-inflammatory, we must be careful when using cortisone for the distal biceps tendon. There is evidence that cortisone injections weaken tendons leading to rupture. Therefore, we must do cortisone injections with ultrasound to avoid injecting directly into the distal biceps tendon. Moreover, we should avoid 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 think this needling causes micro-injuries leading to tendon healing and remodeling.

Finally, we use platelet-rich plasma or 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, surgery results are much better if we repair them within three weeks of the 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, then 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:

• Common elbow, hand, and wrist conditions
• Tennis elbow
• Golfer’s elbow
• Crossfit elbow injuries