Overview

Bicep tendonitis at the elbow, is an inflammation of the tendons that connect the biceps muscle, to the elbow. The degeneration is often caused from a lifetime of normal activity but can worsen with repetitive elbow motion and rotation. In other instances, injury can occur when the elbow is forced straight against resistance, or a heavy load. Bicep tendonitis elbow typically heals between 6 weeks to 3 months, depending upon the severity, however resting the arm is required to avoid partial or full tear of the tendon, that could require surgery.

Anatomy

The biceps muscle has two tendons, one that attach the muscle to the shoulder, and the other tendon to the elbow (also called the distal biceps tendon). Bicep tendonitis elbow typically occurs at the insertion of the biceps tendon on the radial tuberosity, or forearm bone, limiting elbow flexion and rotation of the forearm with the palm upwards (supination).

Symptoms

• Pain or discomfort, swelling, visible bruising at the front of the elbow and forearm
• Exacerbated pain and weakness when bending the elbow and rotating the forearm (supination)
• A bulge near the top of the biceps muscle
• A gap in the front of the elbow

Causes

Inflammation and injury to the tendon at the elbow is uncommon, however when it occurs, it is typically a result of overuse and repetitive motions of the joint. Sports that involve repetitive overhead motion or overuse of the elbow joint, such as tennis and gymnastics, can cause bicep tendonitis elbow. In more severe cases, it can be caused when lifting heavy objects, increasing stress on the biceps, in which the tendon can tear away from the bone.

Diagnosis

Bicep tendonitis of the shoulder is diagnosed by assessing elbow pain in the antecubital fossa (front crease of elbow) and palpate for tenderness and a gap in the tendon. Pain and weakness with supination of the forearm may also be examined against resistance. Imaging techniques may also be recommended such as an X-ray or MRI, that can be helpful when there is partial tearing of the tendon and detect for any fluid around the site. In severe cases during a complete tear, a PRP injection or a repair may be advised.

Treatment

Simple treatments typically heal bicep tendonitis in the elbow, such as resting the affected arm or actively modifying and avoiding provocative exercises. Strengthening exercises of the bicep may be recommended, starting with a light weight, and progressively increasing, could help to relieve lower bicep pain, and restore normal function as pain subsides. Exercises could included bicep curls (gradually adding or increasing weight), bicep stretch, internal (+ external) rotation stretch, and forearm twists. In other instances where exercises do not improve bicep tendonitis elbow, injections such as cortisone, needle tenotomy, or platelet-rich plasma (PRP) can help to reduce tendon swelling and stimulate healing.

Exercises

• Eccentric curls: Hold a dumbbell in one hand and curl the weight up with your bicep muscle. Then, slowly lower the weight down to the starting position, taking at least 3-4 seconds to do so. Repeat for several repetitions.
•  Hammer curls: Hold a pair of dumbbells with your palms facing each other and curl the weights up to shoulder level, keeping your elbows close to your sides. Lower the weights back down and repeat.
• Reverse curls: Hold a barbell with an overhand grip (palms facing down) and curl the weight up towards your shoulders. Lower the weight back down and repeat.
•  Triceps extensions: Hold a dumbbell with both hands and extend your arms overhead, keeping your elbows close to your ears. Lower the weight back down and repeat.
• Wrist curls: Hold a light dumbbell in one hand and rest your forearm on a table or bench with your palm facing up. Curl the weight up towards your wrist, then lower it back down and repeat.

Prevention

Preventing bicep tendonitis is always better than having to treat it later. Here are some tips to help prevent the condition:

• Warm-up: Always perform a proper warm-up before any workout or physical activity. This can include light cardio, stretching, and dynamic movements that prepare your body for exercise.
• Gradual progression: Gradually increase the intensity, duration, and frequency of your workouts. Avoid sudden changes in your exercise routine as this can put excess strain on your bicep tendon.
• Proper technique: Use proper technique when performing exercises to prevent excessive stress on your bicep tendon. This includes maintaining proper form, avoiding jerky movements, and lifting weights that are appropriate for your strength and fitness level.
• Rest and recovery: Allow your body adequate time to rest and recover between workouts. This means taking rest days, getting enough sleep, and eating a balanced diet to support muscle recovery.
• Get a regular sports massage or deep tissue massage by a certified professional in sports rehabilitation or sports therapy.
• Stretching and mobility: Incorporate stretching and mobility exercises into your routine to maintain flexibility and prevent tightness in your bicep muscles and tendons.
• Avoid overuse: Avoid repetitive activities that can cause overuse of your bicep tendon, such as excessive typing or gripping activities.