Diagnosis and Management of Distal Biceps Tendinopathy

Clinical Examination

Patients typically present with insidious onset of load-related localized pain in the antecubital fossa that coincides with increased activity 3
Pain is initially present during activity but may subside after a warm-up period; it gradually increases in intensity and duration, potentially becoming present at rest in later stages 3
Physical examination should include inspection for muscle atrophy, asymmetry, swelling, and erythema 3
Well-localized tenderness on palpation that reproduces the patient's pain 3
Physical maneuvers that simulate tendon loading and reproduce the patient's pain 3

Plain radiographs should be the initial imaging study to rule out associated fractures or other bony abnormalities 2, 1
MRI without contrast is the preferred next imaging study with superior accuracy (86.4%) compared to ultrasound (45.5%) for biceps tendon pathology 1, 2
The FABS (flexion-abduction-supination) view is recommended for optimal visualization of the distal biceps tendon on MRI 2, 1
Patient is imaged in prone position with elbow flexed at 90°, shoulder abducted, and forearm supinated 2
This view allows visualization of the entire tendon on a single image 2
Ultrasound can be considered as an alternative when MRI is contraindicated, but has limitations in detecting partial tears and tendinopathy 1

Failing to distinguish between partial and complete tears, which requires accurate imaging (preferably MRI) 1
Relying solely on ultrasound for diagnosis, which has limitations in accuracy compared to MRI 1
Missing associated pathologies that may contribute to symptoms 3, 2