Biceps Tendon Tendinitis (Distal)

with Rehab

Tendinitis involves inflammation and pain over the affected tendon. The distal biceps tendon (near the elbow) is vulnerable to tendinitis. Distal biceps tendonitis is usually due to the bony bump near the elbow (bicipital tuberosity) causing increased friction over the tendon. The biceps tendon attaches the biceps muscle to one bone in the elbow and two in the shoulder. It is important for proper function of the elbow and for turning the palm upward (supination).

SYMPTOMS

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

  • Pain when bending the elbow or turning the palm up, using the wrist, especially if performed against resistance.

  • Crackling sound (crepitation) when the tendon or elbow is moved or touched.

CAUSES

The symptoms of biceps tendonitis are due to inflammation of the tendon. Inflammation may be caused by:

  • Strain from sudden increase in amount or intensity of activity.

  • 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.

RISK INCREASES WITH:

  • Sports that involve contact or overhead arm activity (throwing sports, gymnastics, weightlifting, bodybuilding, rock climbing).

  • Heavy labor.

  • Poor strength and flexibility.

  • Failure to warm up properly before activity.

  • Injury to other structures of the elbow.

  • Restraint of the elbow.

PREVENTION

  • Warm up and stretch properly before activity.

  • Allow time for recovery between activities.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Learn and use proper exercise technique.

PROGNOSIS

With proper treatment, biceps tendon tendonitis is usually curable within 6 weeks.

RELATED COMPLICATIONS

  • Longer healing time if not properly treated or if not given enough time to heal.

  • Chronically inflamed tendon that causes persistent pain with activity, that may progress to constant pain and potentially rupture of the tendon.

  • Recurring symptoms, especially if activity is resumed too soon, with overuse or with poor technique.

TREATMENT

Treatment first involves ice and medicine to reduce pain and inflammation. Modify activities that cause pain, to reduce the chances of causing the condition to get worse. Strengthening and stretching exercises should be performed to promote proper use of the muscles of the elbow. These exercise may be performed at home or with a therapist. Other treatments may be given such as ultrasound or heat therapy. Surgery is usually not recommended.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain relieving medication for 7 days before surgery.

  • Prescription pain relievers may be given if your caregiver thinks they are needed. Use only as directed and only as much as you need.

HEAT AND COLD:

  • Cold treatment (icing) should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 weeks, despite treatment.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Biceps Tendon Tendinitis (Distal)

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may go away with or without further involvement from your physician, physical therapist, or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

STRETCH – Elbow Flexors

  • Lie on a firm bed or countertop on your back. Be sure that you are in a comfortable position which will allow you to relax your arm muscles.

  • Place a folded towel under your right / left upper arm, so that your elbow and shoulder are at the same height. Extend your arm; your elbow should not rest on the bed or towel.

  • Allow the weight of your hand to straighten your elbow. Keep your arm and chest muscles relaxed. Your caretaker may ask you to increase the intensity of your stretch by adding a small wrist or hand weight.

  • Hold for __________ seconds. You should feel a stretch on the inside of your elbow. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

RANGE OF MOTION – Supination, Active

  • Stand or sit with your elbows at your side. Bend your right / left elbow to 90 degrees.

  • Turn your palm upward until you feel a gentle stretch on the inside of your forearm.

  • Hold this position for __________ seconds. Slowly release and return to the starting position.

Repeat __________ times. Complete this stretch __________ times per day.

RANGE OF MOTION – Pronation, Active

  • Stand or sit with your elbows at your side. Bend your right / left elbow to 90 degrees.

  • Turn your palm downward until you feel a gentle stretch on the top of your forearm.

  • Hold this position for __________ seconds. Slowly release and return to the starting position.

Repeat __________ times. Complete this stretch __________ times per day.

STRENGTHENING EXERCISES - Biceps Tendon Tendinitis (Distal)

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Increase the resistance and repetitions only as guided.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never get worse during these exercises. If this pain does get worse, stop and make sure you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your clinician.

STRENGTH - Elbow Flexors, Isometric

  • Stand or sit upright on a firm surface. Place your right / left arm so that your hand is palm-up and at the height of your waist.

  • Place your opposite hand on top of your forearm. Gently push down as your right / left arm resists. Push as hard as you can with both arms without causing any pain or movement at your right / left elbow. Hold this stationary position for __________ seconds.

  • Gradually release the tension in both arms. Allow your muscles to relax completely before repeating.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH – Forearm Supinators

  • Sit with your right / left forearm supported on a table, keeping your elbow below shoulder height. Rest your hand over the edge, palm down.

  • Gently grip a hammer or a soup ladle.

  • Without moving your elbow, slowly turn your palm and hand upward to a "thumbs-up" position.

  • Hold this position for __________ seconds. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH – Forearm Pronators

  • Sit with your right / left forearm supported on a table, keeping your elbow below shoulder height. Rest your hand over the edge, palm up.

  • Gently grip a hammer or a soup ladle.

  • Without moving your elbow, slowly turn your palm and hand upward to a "thumbs-up" position.

  • Hold this position for __________ seconds. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH – Elbow Flexors, Supinated

  • With good posture, stand or sit on a firm chair without armrests. Allow your right / left arm to rest at your side with your palm facing forward.

  • Holding a __________ weight, or gripping a rubber exercise band or tubing, bring your hand toward your shoulder.

  • Allow your muscles to control the resistance as your hand returns to your side.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH – Elbow Flexors, Neutral

  • With good posture, stand or sit on a firm chair without armrests. Allow your right / left arm to rest at your side with your thumb facing forward.

  • Holding a __________ weight, or gripping a rubber exercise band or tubing, bring your hand toward your shoulder.

  • Allow your muscles to control the resistance as your hand returns to your side.

Repeat __________ times. Complete this exercise __________ times per day.