Bicipital Bursitis Symptoms Causes Treatment Preventions & More All you need to know
Bicipital bursitis or bicipitoradial bursitis is an inflammation of the bursa lying between the distal end of the biceps tendon and the tuberosity of the radius (the forearm bone).
The anatomy of the bicipital bursa
Bicipital bursa is one of the two bursas present in the cubital fossa. The cubital fossa or the elbow pit is the triangular area on the front of the elbow.
The cubital fossa contains the;
- Radial nerve
- Median nerve
- The biceps brachii tendon
- The brachial artery
Several veins are also present in the fossa, but they lie superficially, more towards the surface, so they are not included in the cubital fossa.
The bicipital bursa wraps around the biceps tendon wholly or partially. It lies between the distal end of the biceps tendon, where it gets attached to the radius and the radial tuberosity.
During pronation and supination of the forearm, the bursa allows for a frictionless movement between the biceps tendon and the proximal end of the radial bone.
In supination of the forearm, when the forearm faces upwards, the bicipitoradial bursa surrounds the biceps tendon.
While in pronation, when the forearm faces downwards, the tuberosity on the radius rotates backward. The movement presses the bicipitoradial bursa against the radial cortex, increasing the pressure within the bursa and the joint capsule.
Causes of bicipital bursitis
Bicipital bursitis is a rare condition.
Sports injuries resulting in traumatic causes of bursitis usually follow repetitive movements at the elbow. This causes stress and strain over the bursa, which rubs against the radial tuberosity and gets inflamed.
Playing games like throwing and hitting a ball involves the elbow joint and may cause tiny tears in the muscle and the associated bursa.
- Repetitive mechanical trauma due to overuse
- Partial tear of the biceps tendon
- Chronic persistent friction
- Direct trauma
All of these incidents may lead to bicipital bursitis in high-risk individuals.
Symptoms of bicipital bursitis
Some common signs and symptoms of bicipital bursitis include;
- Pain in the elbow, more on the upper side of the cubital fossa
- Pain gets worse when the elbow is flexed and extended
- Severe pain that may disturb sleep
- Inability to sleep on the affected side
- Tenderness at the affected site
- Decreased range of motion at the elbow
- Redness and increased warmth of the affected area
- Swelling may or may not be present
- A crunchy feeling or crepitus upon elbow joint movement
- Inability to carry out normal daily activities as brushing your teeth or taking a shower
There may or may not be a history of trauma or any medical illnesses. However, the doctor may find a hard yet tender soft tissue mass in the cubital fossa at the elbow on examination.
In severe cases, when the soft tissue mass, if present, compresses the median nerve, which lies in close proximity to the bursa. This compression results in weakness in the extensor muscles of the forearm.
Compression of the radial nerve may result in a sensory loss at the dorsal surface (opposite to the palm) of the hand and fingers.
MRI of the lesion confirms the diagnosis.
Treatment of bicipital bursitis
- Conservative treatment in the initial week
Immediately after the initial pain starts, the application of the RICER module helps.
Rest the elbow and immobilize it with the help of a sling at a comfortable position.
Ice application or cold compress helps relieve the swelling and pain.
Bursitis may get worse with compression as it puts pressure on the bursa. So a light compression may work.
Keep the arm elevated at a comfortable position with a sling to reduce swelling. Immobilization in a cast may be required in severe cases.
If nothing helps, consult a specialist.
The doctor may prescribe some muscle relaxants to relieve the pain. In addition, over-the-counter analgesics and NSAIDs help manage the condition.
In case of inflammation and fever, the doctor may take out any fluid accumulated and inject antibiotics into the joint.
Severe cases may require corticosteroid injections which help speed up recovery and healing.
TENS brings effective relief in cases of bursitis, including bicipital bursitis. It sends electrical impulses of low voltage to stimulate the nerve supply in the affected area. The nerve impulses override the pain impulses sent to the brain, thereby alleviating pain and discomfort.
TENS is also believed to stimulate the release of endorphins, natural chemicals that act as analgesics in the body.
- After the initial few weeks
Once the swelling and pain have subsided, rehabilitative therapy should be initiated. It is essential in people who are involved in active sports and are at high risk for degenerative changes in the bicipital bursa.
Massage can help with bicipital bursitis in the later subacute stages after about three weeks.
Arm massage helps release tension in the biceps and its tendons. This, in turn, helps to relax the muscle and ease away any pressure on the bursa.
The bursa gets time to heal when the local circulation is increased. Massage also reduces car formation in the tissues and the tendons.
Kneading, a soft tissue technique, enhances the removal of tissue waste from the affected area.
- Therapeutic ultrasound
Therapeutic ultrasound helps in the same way as massage does. The technique involves stimulating the tissue spaces within muscles and tendons. As a result, circulation increases, wastes are removed, and nutrients replenished.
- Active rehabilitation
Some exercises to actively rehabilitate the elbow joint include;
Elbow flexion stretch
- Lift the affected arm and bend the elbow with your palm facing you.
- With your healthy hand, gently push your affected forearm at the end of the flexion.
- You should be able to feel a stretch in the back of your affected upper arm.
- Hold the stretch for fifteen seconds, then slowly bring it back to the starting position.
- Repeat at least five times.
Elbow extension stretch
- Extend your affected arm.
- Let your palm face away from you as if you are giving a push.
- With your other hand, slowly bend the back of your wrist of the affected arm so that the fingers point to the ceiling.
- Stretch your extended arm and hand and hold the stretch for at least five seconds.
- Repeat five times.
- Now extend your arm with the palm facing upwards.
- Bend the back of your wrist with the other hand so that your hand points to the floor.
- Hold the stretch for at least five seconds and release.
- Repeat at least five times.
Pronation and supination stretch
- Keep your affected arm by your side.
- Bent the elbow at about 90 degrees.
- Grasp a pen in your hand of the affected. You can make a fist instead of holding a pen.
- Slowly turn your forearm with your palm facing up and down alternately.
- Hold each position for about five seconds.
- Perform at least ten times.
Prevention of bicipital bursitis
- Make sure to perform warm-up and cool-down exercises adequately.
- Altogether avoid the activity that flares up pain in the elbow.
- Redesign your job and sports activities that involve overhead movements.
- Practice range-of-motion exercises as they are essential to ensure minimal functional disturbance.
- Make use of splints or bands to decrease the strain on the elbow.