Ultrasound-Guided Cortisone Injections for Distal Biceps Tendon Pain

 

Introduction

The distal biceps tendon plays a crucial role in forearm and elbow movement, particularly in flexion and supination (turning the palm upwards). Overuse, repetitive strain, or acute trauma can lead to inflammation, microtears, or even rupture, causing pain and dysfunction.

Patients with distal biceps tendon pain often experience localised discomfort near the elbow, weakness, and difficulty in lifting objects. While rest, physiotherapy, and NSAIDs can help in early cases, persistent pain may require interventional treatments such as ultrasound-guided cortisone injections to reduce inflammation and improve function.

This blog provides a detailed overview of the distal biceps tendon, including its anatomy, pathology, symptoms, and treatment options, with a focus on how ultrasound-guided cortisone injections can be used for symptom relief.



Anatomy of the Distal Biceps Tendon

The biceps brachii muscle consists of two heads:

  • Long head – Originates from the supraglenoid tubercle of the scapula.
  • Short head – Originates from the coracoid process of the scapula.

Both heads merge to form a single muscle belly that extends distally into the distal biceps tendon, which inserts onto the radial tuberosity of the radius.

Functions of the Distal Biceps Tendon

  • Flexion of the elbow joint – Bending the forearm towards the upper arm.
  • Supination of the forearm – Rotating the forearm to turn the palm upwards.
  • Provides dynamic stability to the elbow joint.

Due to its function, the distal biceps tendon is prone to overuse injuries, particularly in individuals engaged in weightlifting, manual labour, or racquet sports.

Pathology of Distal Biceps Tendon Injuries

Distal biceps tendon pathology can occur due to repetitive strain, acute trauma, or degenerative changes.

1. Distal Biceps Tendinitis

  • Inflammation of the distal biceps tendon due to overuse.
  • Common in athletes or individuals performing repetitive lifting.
  • Leads to pain, tenderness, and mild swelling near the elbow crease.

2. Partial Distal Biceps Tendon Tear

  • Occurs due to microtears in the tendon fibres.
  • Can develop gradually from chronic tendinopathy or suddenly due to a high-force movement.
  • Symptoms include sharp pain, weakness, and reduced grip strength.

3. Complete Distal Biceps Tendon Rupture

  • A full-thickness tear leading to detachment of the tendon from the radial tuberosity.
  • Usually occurs due to a sudden eccentric contraction of the biceps under load (e.g., lifting a heavy object).
  • Causes severe pain, bruising, and a noticeable bulge (‘Popeye deformity’) due to muscle retraction.
  • Requires surgical repair, as the tendon does not heal on its own.

Symptoms of Distal Biceps Tendon Injuries

  • Pain at the front of the elbow, especially with movement.
  • Weakness in elbow flexion and forearm supination.
  • Tenderness over the distal biceps tendon.
  • Clicking or popping sensation in some cases.
  • Bruising and swelling in cases of acute tears.

Symptoms worsen with activity, particularly lifting, gripping, or rotating the forearm.

Diagnosis of Distal Biceps Tendon Injuries

Diagnosis is based on clinical assessment and imaging studies.

1. Clinical Examination

  • Palpation of the distal biceps tendon to identify tenderness or gaps.
  • Hook Test – Used to assess tendon integrity.
  • Range of Motion Test – Evaluating movement limitations.
  • Strength Testing – Assessing flexion and supination strength.

2. Ultrasound Imaging

  • Detects tendinopathy, partial tears, or thickening.
  • Provides real-time visualisation for precise injections.
  • Helps differentiate inflammatory vs. structural injuries.

Management of Distal Biceps Tendon Pain

1. Conservative Treatment

  • Rest and activity modification to avoid further strain.

For persistent or moderate-to-severe pain, ultrasound-guided cortisone injections are considered.

Ultrasound-Guided Cortisone Injections for Distal Biceps Tendon Pain

Cortisone injections contain corticosteroids, which help reduce inflammation and pain. When administered under ultrasound guidance, cortisone can be precisely injected around the distal biceps tendon, avoiding unintended damage.

Mechanism of Action of Cortisone Injections

  • Inhibits inflammatory mediators (e.g., prostaglandins, cytokines).
  • Reduces capillary permeability, decreasing swelling.
  • Suppresses immune cell activity, limiting the inflammatory response.

Benefits of Cortisone Injections

  • Provides rapid pain relief.
  • Reduces inflammation and swelling.
  • Improves range of motion and function.

Cortisone injections are most effective for tendinitis, but their use in tendon tears is limited due to concerns about tendon weakening.

Ultrasound-Guided Injection Procedure

At Alton Pain Clinic, the procedure is performed using real-time ultrasound guidance to ensure accuracy and safety.

Step-by-Step Process

  1. Ultrasound Scan – To identify the precise injection site.
  2. Skin Preparation – The area is cleaned and sterilised.
  3. Local Anaesthesia – Numbing the injection site.
  4. Guided Cortisone Injection – Administering cortisone around the tendon sheath.
  5. Post-Injection Care – Advice on rest and rehabilitation.

The procedure is minimally invasive and performed in an outpatient setting.

Rehabilitation and Recovery

  • Avoid excessive strain on the tendon for a few days post-injection.
  • Gradual return to physiotherapy exercises.
  • Strengthening the biceps and forearm muscles to prevent recurrence.
  • Follow-up appointments to monitor progress.

Conclusion

Distal biceps tendon injuries can cause significant pain and functional limitations, particularly in individuals engaged in heavy lifting or repetitive arm movements. Ultrasound-guided cortisone injections can provide targeted pain relief, helping patients regain mobility and function.

At Alton Pain Clinic, advanced ultrasound techniques are used to ensure precise and effective injection therapy. If you are experiencing persistent distal biceps tendon pain, seeking expert evaluation and appropriate treatment may help restore function and quality of life.

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