Abstract
CASE HISTORY: A 44-year-old male avid weightlifter presented to the clinic for evaluation of acute onset distal bicep pain following a weightlifting session. He reports feeling a pop in his right distal bicep while performing a preacher curl and subsequently dropping the weight. PHYSICAL EXAM: Examination of the right arm demonstrated guarding with the elbow held in slight flexion without obvious deformity. Ecchymosis was noted on the volar aspect of the proximal forearm. Tenderness to palpation was present along the distal bicep tendon, as was elicitation of pain and weakness with resisted elbow flexion and supination. DIFFERENTIAL DIAGNOSES: Partial rupture of the distal biceps tendon; Complete rupture of the distal biceps tendon; Distal biceps tendonitis; Avulsion fracture of the radial tuberosity. TESTS & RESULTS: In-office ultrasound of the right distal bicep which showed significant disorganization, hypoechoic thickening, and a high-grade partial tear. He also had an MRI of the right elbow which demonstrated a high-grade partial thickness tear of the distal biceps tendon in the setting of tendinosis. FINAL DIAGNOSIS: Acute, high-grade partial thickness tear of the distal biceps tendon. DISCUSSION: Distal biceps tendon tears are common among male weightlifters, particularly in their dominant extremity due to an extension force applied to a flexed arm. This can result in significant loss in muscle function, range of motion, and strength. The current standard of care is surgical intervention for distal bicep tendon tears with greater than 50% of tendon involvement. Additionally, patients with supination weakness were 24 times more likely to undergo surgical repair. However, the use of platelet-rich plasma (PRP) is emerging as a practical non-operative and non-invasive way to manage a partial tear conservatively. PRP is a widely used sports medicine modality that accelerates recovery through decreasing inflammation and facilitating tissue regeneration. Ultrasound guidance enhances the precision of PRP delivery, ensuring accurate peritendinous localization to optimize therapeutic effect. Higher PRP doses have been linked to better clinical outcomes such as pain relief and functional improvement, as well as improved tendon morphology on radiographic imaging. The patient’s quick recovery evidenced by the findings 4 weeks status post-treatment with PRP is uncommon. Other non-operative treatment modalities take greater than 6 months to demonstrate symptom improvement. OUTCOME OF THE CASE: There was discussion with the patient regarding his diagnosis, treatment options for a high-grade partial thickness tear of the distal bicep, and his desire to avoid surgery. After further discussion, high dose leukocyte-poor PRP (LP-PRP) treatment utilizing ultrasound guidance was performed to the distal biceps tendon. Follow-up at 4 weeks showed significant improvement in tissue architecture, tension, and pain. Four weeks after initial treatment, a second treatment of high dose LP-PRP to the right distal biceps tendon was performed utilizing ultrasound guidance. The patient engaged in a 6 week rehabilitation program consisting of physical therapy, blood flow restriction, and a Neuro-Bio-Electric Stimulator device. RETURN TO ACTIVITY AND FURTHER FOLLOW-UP: The patient was instructed to refrain from intense weightlifting for 3 months following the initial evaluation. At the 3 month follow up, he reported 95% improvement in pain, function, and strength.
Recommended Citation
Naik, Saahil; Ward, Stephanie; and Broussard, John
(2026)
"Accelerated Recovery Following High-Dose Platelet-Rich Plasma Injection for Distal Biceps Tendon Tear in a Weightlifter,"
International Journal of Exercise Science: Conference Proceedings: Vol. 2:
Iss.
18, Article 253.
Available at:
https://digitalcommons.wku.edu/ijesab/vol2/iss18/253