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
How to Improve HEP Adherence for Optimal Rehabilitation Outcomes
By Sophia Grimm A lack of adherence to home exercise programs in rehabilitation is a significant problem, with nonadherence estimates as high as 30-65% for general musculoskeletal conditions. This could have potentially detrimental effects on patients’ clinical rehabilitation outcomes as the success of certain medical interventions depends largely on patient adherence to advice and prescribed rehabilitation…
Effects of different stretching techniques for improving joint range of motion.
Reference: Oba, K., Samukawa, M., Abe, Y., Suzuki, Y., Komatsuzaki, M., Kasahara, S., Ishida, T., & Tohyama, H. (2021). Effects of Intermittent and Continuous Static Stretching on Range of Motion and Musculotendinous Viscoelastic Properties Based on a Duration-Matched Protocol. International journal of environmental research and public health, 18(20), 10632. https://doi-org.libproxy.nau.edu/10.3390/ijerph182010632 The Skinny: This study used a cross-over…
Thumbs up for treating thumb pain in the hand therapy clinic
What do “Mommy’s thumb,” “gamer’s thumb,” and “radial styloid tenosynovitis” have in common? They are all officially called de Quervain’s tenosynovitis De Quervain’s involves the tendons within the first dorsal compartment, abductor pollicis longus (APL) and extensor pollicis brevis (EPB) and arises when the tendons are inflamed and are not able to move through the…
How much pain should a patient have during and after therapy?
How much pain should a patient have during and after therapy? As we all know pain is somewhat subjective. It can be hard to determine how much pain a patient should experience with the type of injury as well as the type of therapy intervention and hand pain treatment. The saying of “no pain, no…
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.