New Distal Bicep Tendinopathy Provocative Test for Hand Therapist
Filed under Evaluation
Caekebeke, P., Schenkels, E., Bell, S. N., & van Riet, R. (2021). Distal biceps provocation test. The Journal of Hand Surgery.
The Skinny:
These surgeons were looking for a provocative test for distal bicep tendinopathy (distal biceps tendonitis test), specifically partial tears, that was more sensitive and specific. Complete tears are more easily tested in the clinic, but more precise tests are needed for partial tears before MRI use is warranted. This study investigated the merits of the Bicep Provocative Test (BPT).
In The Weeds:
The BPT is conducted with the patient’s arm flexed at 70 degrees. Step one is isometric flexion against resistance in supination. Step 2 (BPTp) is the same stimulus with the forearm in pronation. The pronated position is postulated to create more pain response with this test, given that the distal bicep tendon’s attachment to the radial tuberosity results in different mechanics in supination versus pronation.
“The distal biceps tendon wraps around the radial tuberosity when the arm is pronated, and the tendon is stretched and compressed when the biceps is activated”
The BPT was conducted on 60 individuals in a double-blind manner. Thirty individuals had suspected distal bicep pathology and 30 patients with other pathology of the elbow. Results of the provocative test were confirmed with MRI or from surgical findings.
Taking it Home:
The BPT produced a sensitivity and specificity of 100% each. The pronation position produced increased pain versus the supinated position by 5-6 points on the visual analog scale (0-10). This suggests that the pronated position might be more sensitive on a larger sample size. This provides therapists with a clinic-based provocative test to direct care or outside referral for partial distal bicep tendon pathology.
Rating: 4/5
The sample size for this study was relatively small at 60 participants, and the sensitivity and specificity would almost certainly be less than 100% with more participants. Overall, however, this is a well-written article that introduces a new provocative test that clarifies the identification of an otherwise difficult to diagnose pathology.
3 Comments
Leave a Comment
More To Read
Do you know the secret ingredient to recovering from an injury?
Do you know the secret ingredient to recovering from an injury? I will give you a hint it is 5 letters and begins with the letter S. SLEEP Have you ever asked yourself a question – does sleep help injuries heal? This is for you to share with your patients but also serve as a…
Read More
Comparison of Erb’s Palsy and Klumpke’s Palsy: Symptoms, Presentation, and Treatment Options
What is the brachial plexus? The brachial plexus is a group of nerves originating from the cervical and thoracic nerve roots (from C5 to T1). The brachial plexus forms 5 peripheral nerves of the upper extremity, consisting of the musculocutaneous, median, radial, ulnar, and axillary nerves. This group of nerves supplies motor and sensory innervation…
Read More
Hand Function in Chemotherapy-Induced Peripheral Neuropathy: A Rapid Review
Osumi, M., Sumitani, M., Abe, Hiroaki, A., Otake, Y., Kumagaya, S.-I., & Morioka, S. (2019). Kinematic evaluation for impairment of skilled hand function in chemotherapy induced peripheral neuropathy. Journal of Hand Therapy. (32)1, 41-47. https://doi.org/10.1016/j.jht.2017.06.003 By: Rita Steffes The Skinny: Chemotherapy has many lasting side effects (one of which is hand numbness after chemotherapy), with…
Read More
Sign-up to Get Updates Straight to Your Inbox!
Sign up with us and we will send you regular blog posts on everything hand therapy, notices every time we upload new videos and tutorials, along with handout, protocols, and other useful information.
Thank you for this concise review! You and Josh are great and appreciated!
Thank you, Cece! So great to hear from you.
What are your recommendations for treatment of partial distal bicep tendon tears? Thank you very much.