Case Study by Adam Watts 

Patient Details

  •   47 year old male
  •   Office worker
  •   Generally fit and healthy

 

Key Learning Points

  • Distal biceps tendon pain should be considered in patients presenting with pain anteriorly in the proximal forearm.
  • Sudden onset of pain is suggestive of a tear
  • Distal biceps tendinopathy is on the increase
  • Patients must be advised of the risk of subsequent biceps rupture

 

Case Background

After throwing a stick for his dog, the patient developed sudden onset right forearm pain.

He continued to suffer with ongoing pain on turning door handles and lifting objects with his elbow extended, despite physiotherapy.

On examination there was:

  • No wasting or deformity
  • A full range of flexion and supination, plus a full range of pronosupination
  • No tenderness on palpation 
  • Pain on O’Driscoll’s hook test.  
  • Pain on resisted forearm supination.

 

What treatment did you recommend / undertake

  • MRI scan showed a partial tearing of the distal biceps tendon involving both heads
  • PRP injection into the distal biceps tendon was performed under ultrasound control
  • Surgery was discussed but the patient declined this option. The patient was counselled about the risk of tendon rupture and to seek prompt attention if that were to occur.

 

What post operation rehab was required?

  • Activity modification. Eccentric loading exercises were performed three times daily from flexion in supination to pronation in extension.
  • This resulted in a gradual improvement in forearm pain over twelve weeks.