Chronic distal biceps tendinopathy




Name Tissue Type of pathologies
Acute and chronic muscle aches and pain Muscle Pain management
Acute and chronic cervical and lumbar pain Muscle Idiopathic cervical and low back pain
Acute and chronic soft tissue wounds Skin Wounds
Adhesive capsulitis Joint Capsulitis
Calcifying tendinitis of the shoulder Tendons Tendinopathy
Cellulite Skin Cellulite
Chronic distal biceps tendinopathy Tendons Tendinopathy
Chronic proximal hamstring tendinopathy Tendons Tendinopathy
Diseases secondary to trigger points and myofascial Pain Muscle Myofascial pain syndrome
Golfer’s elbow Tendons Tendinopathy
Greater trochanteric pain syndrome Tendons Tendinopathy
Insertional Achilles tendinopathy Tendons Tendinopathy
Knee osteoarthritis Joint Osteoarthritis
Medial tibial stress syndrome Tendons Tendinopathy
Mid-body Achilles tendinopathy Tendons Tendinopathy
Osgood-Schlatter disease Bone Disturbance of musculoskeletal development
Patella tip syndrome Tendons Tendinopathy
Plantar fasciopathy Tendons Tendinopathy
Primary and secondary lymphedema Skin Lymphedema
Primary long bicipital tenosynovitis Tendons Tendinitis
Proliferative connective tissue disorders Connective tissue Fibrosis
Spasticity Central nervous system Cerebral palsy and stroke
Stress fractures Bone Fracture
Subacromial pain syndrome Tendons Tendinopathy
Superficial nonunions Bone Fracture
Tennis elbow Tendons Tendinopathy
Trigger points Muscle Myofascial pain syndrome


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.


Furia et al., Clin J Sport Med 2017;27:430-437.

Radial extracorporeal shock wave therapy is effective and safe in chronic distal biceps tendinopathy.



Number of treatment sessions 3 to 5
Interval between two sessions 1 week
Air pressure Evo Blue® 2 to 4 bar
Air pressure Power+ 1.5 to 3 bar
Impulses 2,000 on the painful spot
Frequency 8Hz to 12Hz
Applicator 15 mm
Skin pressure Moderate to heavy

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