© Cambridge Fracture Clinic - Mr Lee Van Rensburg - Cambridge; United Kingdom
Cambridge Elbow

Biceps tendonitis

Biceps tendonitis is relatively rare. It is inflammation and swelling around the biceps tendon and bicipital

bursa. The pain is felt in the front of the elbow, and deep inside, made worse with flexion (bending the

elbow) and particularly made worse with supination (twisting the forearm asking for change palm up). There

is often an underlying condition that makes someone prone to tendon and or bursal inflammation. If the

pain follows an acute traumatic event it may be a complete rupture or partial rupture of the biceps tendon

(see distal biceps tendon rupture). There are a few other rarer causes for pain in the front of the elbow.

Nerve compression

o

LABCN - the lateral antebrachialcutaneous nerve exits under the biceps tendon and can be

compressed, causingpain and discomfort radiating down the front of the elbow into the

lateralaspect of the forearm. (Bassett lesion)

o

Median nerve compression - themedian nerve can be compressed at the elbow in several

places.

Diagnosis

It is often possible clinically to diagnose the cause of pain in the front of the elbow. An x ray will show if there are any problems with the bones and

elbow joint. An MRI scan may be needed to show the tendon and bursa looking for partial or complete tears of the tendon and any evidence of

inflammation of the bicipital bursa. Nerve conduction studies may be needed to see if there is any compression of the nerves across the elbow.

 Treatment

 Treatment is mostly directed at the underlying condition.

 General treatment includes:

Rest -  relative rest (doingnothing is often as bad as doing too much, muscles ligaments and bones like tobe gently stressed while healing).

Activity modification - Avoid thoseactivities that precipitate the pain

Reducing the inflammation - NSAID'sand steroid injection (steroid injections are in general controversial andaround the front of the elbow only

very rarely used.)

Surgery

The need and kind of surgery depends on the cause.

Chronic tendinosis/tendinitis - ifconservative treatment fails surgery is aimed at promoting a healing responseby the body.

o

Partial ruptures/ tears of thetendon  are treated with debridement and excision of the bicipitalbursa. If only a few fibres of the tendon

remain attached to the bone, thenit is sometimes best to formally detach the remaining tendon and repair it back downonto the bone

with sutures.

Trauma and biceps tendon tears.

 See (distal biceps tendonrupture) forcomplete tears of the biceps tendon.

Nerve compression syndromes, theseare rare. If present surgery is directed at releasing the area of compression. (Bassett lesion)

References

 Compression of the musculocutaneous, nerve at the elbow; Bassett FH III, Nunley JA.; J Bone Joint Surg Am. 1982;64:1050–1052

Gillingham BL, Mack GR. Compression of the lateral antebrachial cutaneous nerve by the biceps tendon. J Shoulder Elbow Surg. 1996;5:330–332.

© Advanced Nerve Blocks

Biceps tendonitis

Biceps tendonitis is relatively rare. It is inflammation and swelling

around the biceps tendon and

bicipital bursa. The pain is felt in the

front of the elbow, and deep inside,

made worse with flexion (bending

the elbow) and particularly made

worse with supination (twisting the

forearm asking for change palm

up). There is often an underlying

condition that makes someone

prone to tendon and or bursal

inflammation. If the pain follows an

acute traumatic event it may be a

complete rupture or partial rupture

of the biceps tendon (see distal

biceps tendon rupture). There are a

few other rarer causes for pain in

the front of the elbow.

Nerve compression

o

LABCN - the lateral antebrachialcutaneous nerve exits

under the biceps tendon and can be compressed,

causingpain and discomfort radiating down the front of the

elbow into the lateralaspect of the forearm. (Bassett lesion)

o

Median nerve compression - themedian nerve can be

compressed at the elbow in several places.

Diagnosis

It is often possible clinically to diagnose the cause of pain in the front of

the elbow. An x ray will show if there are any problems with the bones

and elbow joint. An MRI scan may be needed to show the tendon and

bursa looking for partial or complete tears of the tendon and any

evidence of inflammation of the bicipital bursa. Nerve conduction

studies may be needed to see if there is any compression of the nerves

across the elbow.

 Treatment

 Treatment is mostly directed at the underlying condition.

 General treatment includes:

Rest -  relative rest (doingnothing is often as bad as doing too

much, muscles ligaments and bones like tobe gently stressed

while healing).

Activity modification - Avoid thoseactivities that precipitate the

pain

Reducing the inflammation - NSAID'sand steroid injection (steroid

injections are in general controversial andaround the front of the

elbow only very rarely used.)

Surgery

The need and kind of surgery depends on the cause.

Chronic tendinosis/tendinitis - ifconservative treatment fails

surgery is aimed at promoting a healing responseby the body.

o

Partial ruptures/ tears of thetendon  are treated with

debridement and excision of the bicipitalbursa. If only a few

fibres of the tendon remain attached to the bone, thenit is

sometimes best to formally detach the remaining tendon

and repair it back downonto the bone with sutures.

Trauma and biceps tendon tears.

 See (distal biceps tendonrupture) forcomplete tears of the biceps

tendon.

Nerve compression syndromes, theseare rare. If present surgery is

directed at releasing the area of compression. (Bassett lesion)

References

 Compression of the musculocutaneous, nerve at the elbow; Bassett FH

III, Nunley JA.; J Bone Joint Surg Am. 1982;64:1050–1052

Gillingham BL, Mack GR. Compression of the lateral antebrachial

cutaneous nerve by the biceps tendon. J Shoulder Elbow Surg.

1996;5:330–332.

Cambridge Fracture Clinic