Chronic distal biceps tendinopathy
CONSULT TREATMENT PROTOCOL

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Chronic distal biceps tendinopathy (cDBT) is characterized by activity related antecubital elbow pain, weakness and loss of function. The condition usually occurs in the dominant arm of middle aged wrestlers, weight lifters, body builders, archery athletes, racquet sport athletes and those whose job requires repetitive forearm rotation.

Usually the disease starts with an acute phase as a result of repetitive microtrauma. Without proper rest the pathology may progress to tendinopathy and ultimately loss of some function. As with many tendinopathies, the exact etiology and natural history of cDBT are mostly unknown. Patients usually experience a deep, dull, burning pain localized to the antecubital fossa. Pain usually worsens several hours after activity and improves with rest. Other typical clinical signs of cDBT are difficulty with heavy lifting, pain after “arm workouts” with weights and pain when using a screwdriver or pulling back an archery bow.

Furthermore, patients may experience a decrease in endurance and/or strength of elbow flexion and forearm rotation, with supination being more often affected than flexion.

There is no consensus regarding the best treatment for cDBT, and many different types of conservative treatment have been described, including relative rest, activity modification, oral and topical anti-inflammatory medication, physical therapy, stretching and strengthening, and splinting. Injections of corticosteroids are avoided because they may further weaken a diseased tendon. Surgical treatment is recommended only when conservative treatment fails.

However, the vast majority of the corresponding studies were small, retrospective case series. It should be noted that after surgery, most authors reported favourable patient outcomes but lengthy postoperative recoveries, transient nerve palsies and prolonged time off work.