Distal Biceps Tendinosis M70.30 726.39

 
ICD-9 Classification / Treatment
Etiology / Natural History Associated Injuries / DDx
Anatomy Complications
Clinical Evaluation Follow-up Care
Xray / Diagnositc Tests Review References

synonyms:

Distal Biceps Tendinitis ICD-10

Distal Biceps Tendinitis ICD-9

 726.39 Enthesopathy of elbow region: other

Distal Biceps Tendinitis Etiology / Epidemiology / Natural History

  •  Has been associated with manual labor work with heavy or repetitive elbow flexion and suppination.
  • Assocaited with gymnastics, weightlifting, bodybuilding, rock climbing

Distal Biceps Tendinitis Anatomy

  • The distal biceps tendon runs in a sheath lateral to the median nerve and brachial artery and medial to the ulnar nerve.
  • Distal biceps tendon has two distinct heads: a continuation of the long head and of the short head. Short head inserts distal to the radial tuberosity, acting more as an elbow flexor. Long head inserts into the radial tuberosity, acts more a supinator. (Eames MH, JBJS 2007:89A:1044).
  • (Mazzocca AD, JSES 2007;16:122).

Distal Biceps Tendinitis Clinical Evaluation

  • Patients complain of pain and swelling in the antecubital fossa which is worse with elbow activities. 
  • Tenderness along the distal biceps tendon.
  • Increased pain with suppination against resistance

Distal Biceps Tendinitis Xray / Diagnositc Tests

  •  A/P, lateraland oblique elbow films indicated. Generally no osseous changes.
  • MRI: may demonstrate partial thickness tearing of the distal biceps tendon near the insertion.

Distal Biceps Tendinitis Classification / Treatment

  • Non-operative:  activity modification, avoidance of provocative activities, ice, NSAIDs.  Gentle stretching and  strengthening with physical therapy may be beneficial.
  • Operative: indicated after failure of non-operative treatment.  Distal biceps tendon debridement with Distal Biceps tendon Repair. 

Distal Biceps Tendinitis Associated Injuries / Differential Diagnosis

  • Cubital bursitis(enlargement of bursal sac that lies between bideps tendon and anterior radial tuberosity)
  • Partial biceps tendon rupture
  • Entrapment of lateral antebrachial cutaneous nerve
  • Elbow dislocation
  • Radial head fracture
  • Distal Biceps Tendon Rupture

Distal Biceps Tendinitis Complications

  • Infection
  • Nerve injury (lateral antebrachial cutaneous, radial/posterior interosseous, median)
  • Rerupture (<5%)
  • Bone tunnel fracture
  • Radioulnar synostosis: generally from subperiosteal disssection of the ulna in two incision approaches. Dorsal approaches spliting the extensor carpi ulnaris and extensor digitorum communis without exposing the radius reduce the risk.
  • Stiffness
  • Anterior elbow pain
  • heterotopic ossification
  • CRPS
  • Kelly EW, JBJS, 2000;82A:1575

 

Distal Biceps Tendinitis Follow-up Care

After operative Debridement and distal biceps tendon repair:

  • immobilized at 90 degrees elbow flexion, forearm in neutral 7-10days.
  • Hinged flexion-assist splint with 30 degree extension block until 8wks.  May block extension at up to 75 degrees for tenuous repairs and extend 20 degrees per week starting at 6weeks post-op.
  • full-extension at 10wks
  • Active flexion begins at 8wks, strengthening at 12wks, unrestricted use at 16wks
  • full strength and endurance expected at 1 yr
  • Morrey = 97% flexion strength, 95% supination strength compared to uninjured extremity.
  • Distal Biceps Repair Rehab Protocol.

Distal Biceps Tendinitis Review References