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.

3 Comments

  1. Cece Skotak on January 10, 2022 at 5:00 pm

    Thank you for this concise review! You and Josh are great and appreciated!

    • Miranda Materi on January 10, 2022 at 7:21 pm

      Thank you, Cece! So great to hear from you.

  2. Kathleen on January 11, 2022 at 3:40 am

    What are your recommendations for treatment of partial distal bicep tendon tears? Thank you very much.

Leave a Comment






More To Read

Factors that influence orthosis adherence in patients with acute traumatic tendon injuries to the hand

September 12, 2021

Savaş, S., & Aydoğan, Ç. (2020). Factors affecting orthosis adherence after acute traumatic hand tendon repairs: A prospective cohort study. Journal of Hand Therapy, S0894113020301848. https://doi.org/10.1016/j.jht.2020.10.005 World Health Organization. (2003). Adherence to long-term therapies: evidence for action. World Health Organization. The Skinny Adherence to orthosis wear is vital for protecting healing tendons after a traumatic tendon…

Read More

What to Know as a Hand Therapist When Choosing Thermoplastic Orthosis Material

October 22, 2023

By: Kelsey Melton Thermoplastic materials can have a variety of properties. Each supplier has a different version of each combination of variables for the therapist to choose from. The most common brands used for orthosis fabrication are Orfit, NorthCoast Medical (NCM), and Raylan. These brands all have their versions of thermoplastic material that vary in…

Read More

Increasing Shoulder Range of Motion by improving Scapulohumeral Rhythm

September 15, 2019

Scapulohumeral rhythm is often the key component when treating shoulder conditions and the reason for the lack of total shoulder range of motion. This may also be a critical component in order to prevent shoulder conditions during rehabilitation of other upper extremity conditions such as distal radius fractures, tendon injuries, and elbow injuries. Scapulohumeral rhythm…

Read More
Envelope_1

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.