Biceps Insertional Enthesopathy

[Littlefoot]

Hi,

I am a junior physiotherapist on my first outpatients rotation and am sometimes feeling a little out of my depth.

I currently have a 40 year old gentleman who has been referred by the orthopaedic consultant for biceps insertional enthesopathy. The gentleman reports pain in approximately an inch from the elbow joint in his forearm. He has experienced no trauma and has gradually got worse over time. He reports that there is decreased strength in his arm on carrying heavy objects.

On assessment the gentleman has full ROM in his shoulder, elbow, neck and wrist with no pain on any of the movements. All ULTT are negative as are neurointegrity test.

He elicites pain on resisted supination and pronation at the radioulnar joint. It is also tender to palpate around the radiulnar joint in supination, but not pronation. However isometric muscle strength appears normal. Have tested all shoulder special test which I can think of an they are all negative.

If it is biceps insertional enthesopathy as the consultant has stated are there any physiotherapy treatments that are effective?

Suppose help is really needed.

Thanks Sarah

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[Fisiomarc]

If there are soft tissues involved, a very located massage -Cyriax- could be a good idea. Try not so strong and test every 5 minutes. If is getting well, keep going for 15-30 minutes. Repeat every 2 or 3 days. If it doesn´t works we would have to asses other causes (radio-ulnar artic.?)