Patient resources
NHS Lothian MSK Self Help Resources Webpage
NHS Torbay and South Devon: Tendinopathy support video
Definition
Pain at the biceps or triceps insertion.
Typical signs and symptoms
- Biceps produces anterior elbow pain, typically deep in the antecubital fossa on resisted supination.
- Triceps produces well localised pain at the triceps insertion on resisted elbow extension
- Traumatic or atraumatic – usually due to a change in load
- Painful when starting a provocative activity
- May feel stiffness in the morning
Prevalence and risk factors
Biceps tendinopathy is relatively common.
Triceps tendinopathy is less common but occurs occasionally in weightlifters, or industrial workers, where repetitive elbow extension against resistance is required.
Other risk factors include: a change in load through the arm or elbow, certain medical conditions and metabolic factors (e.g. high cholesterol, inflammatory conditions, diabetes, obesity), lack of quality sleep, stress, long term and excessive alcohol intake, smoking, genetics, obesity; certain medications such as antibiotics (e.g. fluoroquinolones) and steroids.
Prognosis/ risk factors for poor outcome
- Most patients improve with non-operative management.
- Can improve within weeks to months depending on contributing factors.
- May persist for several years.
- Risk factors for poor outcome may include: higher pain severity and disability at baseline, longer pain duration, multi-site pain, previous pain episodes, anxiety and/or depression, stress, adverse coping strategies, poor self-efficacy, low social support, low expectations of recovery, lack of quality sleep, lifestyle e.g. smoking, alcohol, physical activity levels; medical co-morbidities including diabetes, inflammatory conditions, high cholesterol, obesity; occupational stress; the use of medications such as antibiotics and steroids may also influence recovery.
Differential diagnoses
- Elbow osteoarthritis
- Rheumatoid arthritis
- Gout
- Intra-articular loose body
- Olecranon bursitis
- Olecranon stress fracture
- Posterior elbow impingement
P.A & M.A- 15-7-26
Who can refer:
- All primary care clinicians with relevant appropriate scope of practice i.e. GPs, Primary care MSK advanced practice physiotherapists, advanced nurse practitioners
- Patient self referral (resident of East Lothian HSCP, Edinburgh HSCP and West Lothian HSCP Where To Find Us – Musculoskeletal Physiotherapy)
- Secondary care consultants and associated teams
- MSK physiotherapists who identify patients with suspected serious conditions of the shoulder or elbow shoulder follow agreed pathways and processes NHS Lothian Integrated Shoulder & Elbow Service
Who and How to refer:
| Condition | Referral Type | Referral destination and process |
|---|---|---|
| Suspected septic arthritis/ septic bursitis | Same day | Orthopaedic registrar via Flow navigation centre on 03000 134000/ on call Orthopaedic registrar via switchboard 0131 242 1000 |
| Suspected facture or dislocation | Same day | Orthopaedic registrar via Flow navigation centre on 03000 134000/ on call Orthopaedic registrar via switchboard 0131 242 1000 |
| Suspected acute distal biceps rupture | Same day | Orthopaedic registrar via Flow navigation centre on 03000 134000/ on call Orthopaedic registrar via switchboard 0131 242 1000 |
| Suspected acute traumatic rotator cuff tear in the younger patient | Urgent | Orthopaedics via SCI gateway > Lauriston Buildings > Orthopaedics- Elbow & Shoulder |
| Suspected malignancy/ tumour specific to shoulder* | Urgent | Orthopaedics via SCI gateway > Lauriston Buildings > Orthopaedics- Elbow & Shoulder |
| Suspected inflammatory condition | Consider referral to Rheumatology – see RefHelp Rheumatology. | |
| Suspected neurological condition | Consider referral to Neurology – see RefHelp Neurology. |
* Please also see Sarcoma – RefHelp. If clinical assessment leads to a very strong suspicion of suspected underlying malignancy, with no specific localising signs or symptoms to suggest a specific underlying primary, consider recommendations and referral options detailed on GP Access to CT for Suspected Cancer (No Clinically Obvious Primary) – RefHelp
Who not to refer:
- Patients who have the presence of significant red flags/ suspicion of serious shoulder and elbow conditions or have suspected inflammatory condition – see serious shoulder & elbow conditions
- Age <16
For further information see associated sections
- Link to NHS Lothian patient internet site including patient information resources – https://services.nhslothian.scot/ISES/Pages/default.aspx
- Link to NHS Inform page shoulder problems https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/self-management-advice/shoulder-problems
- Link to NHS Inform shoulder problems- Patient self help guide https://www.nhsinform.scot/self-help-guides/self-help-guide-shoulder-pain
- Link to NHS Inform page elbow problems https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/self-management-advice/elbow-problems
- Link to intranet site NHS Lothian Integrated Shoulder and Elbow Service http://intranet.lothian.scot.nhs.uk/Directory/physiotherapy/NHSLIntegratedShoulderandElbowService/Pages/default.aspx
