Distal Biceps Brachii Tendinopathy F105

Current RMA Instruments

Changes from previous Instruments

ICD Coding

ICD-10-AM Code: S46.2                  

Brief description

Distal biceps brachii tendinopathy is a condition characterised by pain due to inflammation and/or degeneration of the distal biceps brachii tendon in the arm. The distal biceps brachii tendon connects to the radius (forearm bone) near the elbow. The proximal biceps tendons attach to the bones around the shoulder and are not covered by these SoPs. 

Note that 'tendinopathy is a term usually used to refer to degenerative changes involving the tendon whilst tendinitis is best used when there is acute inflammation. However, these SoPs recognise the potential for both degenerative as well as inflammatory pathology in the tendon. 

If there is an acute injury involving this distal part of the tendon, and there is no evidence to support inflammation and/or degeneration, the 'Sprain and Strain' SoP should be applied. 

Confirming the diagnosis

The diagnosis is made from clinical evaluation, with imaging (often ultrasound as first-line and MRI as gold standard) generally required for confirmation.

To establish this diagnosis, the assessment and/or management may involve consultation with the following medical specialists: orthopaedic surgeons, sports physicians, or rheumatologists. 

Additional diagnoses covered by SOP

• Partial tear of the distal biceps brachii tendon
• Complete tear of the distal biceps brachii tendon
• Distal biceps brachii injury
• Distal biceps brachii tendonitis
• Distal biceps brachii tendoinosis

Diagnoses not covered by SOP

• Bicipitoradial bursitis not accompanied by distal biceps brachii tendinopathy #
• Lateral epicondylitis * Epicondylitis SoP
• Medial epicondylitis *  Epicondylitis SoP
• Radial tunnel syndrome #

* another SOP applies  - the SOP has the same name unless otherwise specified

^# non-SOP condition

Clinical onset

This condition often can occur with a gradual onset due to overuse and repetitive strain. However, it can also develop following a single overloading event. The presentation will reflect the inflammation and/or degeneration involved, with symptoms and signs generally being pain, weakness in bending the arm at the elbow and twisting and lifting movements using the forearm.  

Once the diagnosis has been confirmed, clinical onset can be dated to the onset of the first clinical event or presentation that is judged by a treating medical specialist to be related to the condition.

Clinical worsening

The outcomes for this condition can vary but many individuals respond well to conservative treatment (rest, modification of activities, analgesia, physical therapy, braces, shockwave therapy and corticosteroid injections etc.), though it may take many months for a full recovery. Occasionally surgery may be required.  Delayed treatment, continued overuse or inadequate rehabilitation can all impact the outcome. Evidence of clinical worsening beyond the normal course of the condition is required and seeking advice from treating specialists would be recommended.