New Distal Bicep Tendinopathy Provocative Test for Hand Therapist

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.