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
Comparing Edema and Lymphedema: Understanding the Differences and Treatment Approaches in Hand Therapy
Comparing Edema and Lymphedema: Understanding the Differences and Treatment Approaches in Hand Therapy As hand therapists we often encounter patients presenting with swollen arms, hands, and/ or fingers, often attributing these symptoms to various conditions. Two commonly confused terms in this area are “edema” and “lymphedema.” While both involve swelling, they have distinct causes, presentations,…
Read More
Place-and-Hold Versus Active Mobilization Therapy After Flexor Tendon Repair
Title: Passive Mobilization With Place-and-Hold Versus Active Mobilization Therapy After Flexor Tendon Repair: 5-Year Minimum Follow-Up of a Randomized Controlled Trial Article Review By: Tommi Hintnaus Reference: Chevalley, S., Wangberg, V., Ahlen, M., Stromberg, J., & Bjorkman, A. (2024, October 4). Passive Mobilization With Place-and-Hold Versus Active Mobilization Therapy After Flexor Tendon Repair: 5-Year Minimum…
Read More
Top 6 treatments for Pinky Fractures
Clients who have experienced a fracture of the finger or hand often find it difficult to participate in meaningful occupations. Everyday tasks from grasping items, cutting food, taking lids off containers, turning keys, and many others can be very painful. Pinky fracture is particularly challenging and painful. This is typical because the largest contributor to…
Read More
Why Burnout Happens in Hand Therapy and What We Can Do About It.
Why Burnout Happens in Hand Therapy There are several reasons why burnout can occur, this is especially true for healthcare workers. What We Can Do About It Final Thought:Burnout isn’t a personal failure, it is often a systemic issue. But we do have power over how we respond. As hand therapists, we are experts at…
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.