anterior elbow/distal bicep pain

Medical Q&A [Moderated]
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Doctors, thanks for all you do. You are creating a unique resource that has helped me greatly. I’m going to try to ask a “good” question…sorry for the long read.

I am 39, non-competitive, 5’11 at 80kg male with no high blood pressure or other medical issues that i’m aware of.

From April 2018 I’ve experienced chronic pain in the anterior elbow/distal bicep tendon area of my right arm (in the inside fold of my elbow). It started with a day of doing pull-ups, the pain was not sudden or sharp but rather dull and started off subtly. I ignored it and continued training, but it got worse and has been fairly stagnant for the last month or so as long as I manage around certain things as discussed below. I find it difficult to pin-point the pain (i can’t really find a specific tender spot, or it seems to “move around”, possibly because i keep squeezing/poking at it too much), but it is in the general area of elbow and bicep referenced above.

The following movements generate discomfort or allows me to continue to manage through it, as described:

  • holding elbow flexion with little weight (like holding a cup of coffee) hurts when extending my arm. Once i move it around a bit (elbow flexion and extension) the pain subsides.
  • at full elbow extension i have no pain with a neutral hand position. Holding at full elbow extension, it hurts at the end ranges of external and internal rotation of my hand.
  • heavier weight with pronated grip at full elbow flexion hurts a lot (like a pronated barbell row at the top of the row or holding the barbell for a shoulder press in the bottom position)
  • i seems like warming up the area reduces pain; if i do supinated barbell curls and warm up slowly (meaning slow eccentric warm up) the pain subsides and i can load weight to about 15RM for a relatively pain free 10 reps of barbell curls. I don’t normally curl but it seems like something that could help move blood through the area.
  • DL and Bench don’t hurt at all.
  • I don’t sense muscle weakness.
  • I don’t have tingling or sharp stinging pain, it is more dull and generalized but the pain gets significant.
  • I don’t experience pain when hooking and pulling on the distal bicep tendon.

I think it is distal bicep tendinopathy but not sure if that is right. I’ve also tried to address the issue by warming up the area through eccentric movement and then loading to about 70% to help and strengthen the tendons. Some days it feels like two steps forward one step back, some days the opposite. I’ve not seen a PT for it but I’ve also started avoiding barbell rows and presses, which bothers me since i’m not sure what to supplement those with, outside of DLs.

Any thoughts or recommendations on my self-diagnosis and self-treatment? Should i just keep doing what i’m doing or see someone for an in person professional assessment?

Thanks as always,
Pieter

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You may indeed have a distal biceps tendinopathy, although this is a fairly uncommon tendinopathy to develop. You could also have a partial rupture, or something else entirely.

Regardless, I think you are generally on the right track by continuing to pull (though I’d make sure you aren’t pulling with a mixed grip and that arm supinated), continuing to bench if it’s pain free, doing light curls, and avoiding the rows and chin-ups/pull-ups for now. You mentioned the bottom position of the press bothers it - can you set up a pin press at a particular height (say, at your nose) and see if that’s more tolerable?

1 Like
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Thanks Austin. Maybe not entirely coincidentally it is my usual supinated hand on the DL; i will adjust that going forward just in case. Excited to try the pin press today, thanks for the advice!