Bicep Tendonosis, Partial Tear, Radial Nerve Issue?

Pain & Rehab Forum [Moderated]
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First, I understand if this cannot be answered here.

Long story short. Last May I injured my arm shoveling mulch and then doing pullups next day. Felt a slight strain on the ventral side of right arm halfway between elbow and wrist but stupidly worked out anyway.

No pop or sudden pain just fatigue/straining feeling. Prior to this I had been lifting heavy for a long time, deadlift was pushing 500 pounds. Never had pain or anything but certainly possible I was pushing to hard, damaging it and not knowing and the mulch caused the manifestation.

Initially didn’t lift for almost two months, but still had pain. Power clean seems to be the one lift that really hurts.

Pain was sometimes hard to pin down. Usually stiff in AM, some shoulder tightness. Occasionally radiates up the bicep a little. PT initially thought maybe braccharadialis then supinator. He worked out some tightness he felt but we could never get it 100%.

Never got better, MRI showed no tears, did 36 sessions of PT, never healed. Pain went from 8/10 at its worst to 6/7.

Few months back Doctor said maybe get a second opinion, so he sent me to a hand /arm expert in Philly. Had to wait 6 weeks for appointment…April 3rd appointment moved to June due to Covid-19 but I had a teleconference today. Just Skyped.

Pointed to where the pain was, described symptoms, and doc said he wants a new MRI because they don’t always show partial tears. His guess was possible partial tear or radial tunnel syndrome.

Obviously, I do not expect this to be a priority so I figure I will be in limbo until things settle in the world. Don’t even know when the MRI would be.

Here are my questions, if even answerable on a forum (I don’t take this as medical advice just curious)

  1. Is it possible for tendonosis to be severe enough to cause such discomfort? I never felt a loss of strength per say, but turning a screwdriver kills me and anything where I have to grip a long time hurts. I can pick up my sons but the area hurts and feels weaker. If I play guitar the top part of my forearm gets very fatigued, by the bracchiaradialis. Supination is the only movement that seems to hurt, although if I try to pick up my son like the Lion King that motion hurts the area in the bend of my elbow. But nothing else hurts except supination. When my main orthopedic dr or the PT moved my arm, nothing hurts except supination.

  2. Any way to know what symptoms would favor partial tear vs. radial issue?

  3. How foolish is it to keep lifting through this? Bench and squat don’t bother me, deadlifts with straps don’t bug me and light rows don’t hurt at all. Yesterday I had to remove a downed tree. Arm was killing me gripping the saw but today feels fine.

Any info advice most appreciated.

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@TheGuildedAge - sorry to hear about your situation.

Questions -

  1. We wouldn’t likely call this tendinosis but tendinopathy (see podcast: https://player.fm/series/barbell-med…7-tendinopathy). What you are describing regarding symptoms certainly could be related to a tendinopathy and our management is outlined in the podcast.

  2. Bicipital strains aren’t typically warranting of drastically different management than how we’d approach a tendinopathy. Our timeline is just a bit different typically for return to activity. A tear is a strain and I actually refrain from saying tear in this context as it tends to be a bit fear mongering for folks. A full strain (grade 3 with tendon rupture, think no longer attaching muscle to bone) would be the scenario where surgery may be warranted for a bicipital strain but based on what you’ve told me here, this doesn’t sound like the case.

  3. It’s very rare we recommend ceasing activity, based on what you’ve told me here, I’d recommend finding tolerable activity. See: https://www.barbellmedicine.com/blog…ining-what-do/

If you want further individual guidance, then I’d get a consult with us: https://docs.google.com/forms/d/e/1F…ilUWA/viewform