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Bicipitoradial Bursitis

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Other Names

  • Bicipitoradial bursitis
  • Bicipital Radial Bursitis
  • Cubital Bursitis

Background

  • This page refers to bursopathies of the distal bicipitoradial bursa

History

  • First described in 1988[1]
  • Bicipitoradial bursitis first used by Spence in 1998[2]

Epidemiology

  • Unknown, poorly described in the literature and limited to case reports
  • Typically presents in adults
  • Male > female

Introduction

Diagram shows the position of the bicipitoradial bursa during pronation and supination. With pronation, the interval between the radius and ulna is decreased, resulting in increased intrabursal pressure.[3]
Elbow bursae. a Lateral elbow and b transverse section distal to the elbow joint show bicipitoradial bursa (arrows) and olecranon bursa (curved arrow). Note the brachialis (white area anterior to ulna). B biceps brachii, O olecranon, RT radial tuberosity, U ulna, R radius[4]

General

  • The bicipitoradial bursa lies at the insertion of the biceps tendon on the radial tuberosity
  • Bursitis is rarely seen here but tends to occur due to trauma or overuse
  • Patients present with antecubital mass and painful pronation/supination
  • Treatment is generally conservative and may include aspiration/ injection

Pathophysiology

  • Unusual location for chronic bursitis
  • Mechanical trauma/ overuse
    • Especially activities which include repetitive pronation and supination
  • Can accompany other biceps pathology such as
    • Tendinosis
    • Partial/complete tear[5]
  • Other causes described in the literature
    • Tuberculosis[6]
    • Chemical synovitis
    • Synovial cyst of the anterior elbow capsule
    • Bone proliferation
    • Rheumatological disease

Anatomy of the Bicipitoradial Bursa

  • Located in the cubital fossa
  • Lies between the distal tendon of biceps brachii and the radial tuberosity
  • Function: Reduce friction between the two structures, especially during pronation/supination
  • Lined by synovial membrane and dense, irregular connective tissue
  • May communicate with the interosseous bursa of the elbow
  • Unclear whether it communicates with the elbow joint proper, with studies having mixed findings[1]

Risk Factors

  • Unknown

Differential Diagnosis

Differential Diagnosis Elbow Pain

Clinical Features

Clinical photos showing anterolateral swelling at the proximal forearm in a patient with bicipitoradial bursitis.[7]

History

  • Anterior elbow pain
  • Impairment in range of motion at the elbow
  • Swelling is often present
  • Patients may report a mass or cyst like structure

Physical Exam

  • The bursa may be palpable
  • Flexion/extension may be impaired
  • Swelling/ prominence is often greater in pronation due to narrowing of the space
  • Pronation is often painful
  • If nerve involvement, evidence of neuropathies may be present (median or radial nerve)

Special Tests

  • Needs to be updated

Evaluation

A, Axial section showing surrounding the distal biceps tendon (white arrow). B, Longitudinal section during forearm supination revealing a bursitis with anechoic content measuring 3.21 × 0.92 cm. This bursitis was responsible for a compression of the lateral cutaneous antebrachial nerve. Arrowheads: radial nerve; M: median nerve; A: brachial artery, RT: radial tuberosity, green arrow: humeroradial joint; lateral antebrachial cutaneous nerve (open arrow)[8]
Sagittal (A) and transverse (B) magnetic resonance images showing an extensively distended bicipitoradial bursa surrounding the distal biceps tendon and radial neck.[7]

Radiographs

  • Standard Radiographs Elbow
    • Screening tool, often normal
  • Rare findings[9]
    • Faint calcification in the biceps tendon
    • Roughening of the anterior radial tuberosity

Ultrasound

MRI

  • Findings
    • Bursa contains homogenous fluid collection
    • Hypointense septal structures may be observed
    • Biceps tendon: low intensity on T1/T2

CT

  • Findings
    • Inflamed bursa as a sharp fusiform lesion with thick or thin walls, with uniform density

Classification

  • Not applicable

Management

Nonoperative

  • General
    • Relative rest from offending activities/occupation
    • NSAIDS
  • If Septic Bursitis is a consideration, antibiotics may be indicated

Distal Biceps Tendon and Bicipitoradial Bursa Injection

  • Can be both diagnostic and therapeutic
  • Should be performed under ultrasound guidance
  • Can both aspirate and inject

Operative

  • Indication
    • Failed conservative treatment with recurrence of the enlarged bursa and pain after aspiration
    • Presence of nerve compression with neurological impairment
    • Mechanical limitation to flexion and extension of the elbow
    • Functional impairment
  • Technique
    • Bursectomy

Rehab and Return to Play

Rehabilitation

  • Unknown

Return to Play/ Work

  • Unknown

Prognosis and Complications

Prognosis

  • Unknown

Complications

See Also

Internal

External

References

  1. ↑ 1.0 1.1 Karanjia, N. D., and P. J. Stiles. "Cubital bursitis." The Journal of Bone & Joint Surgery British Volume 70.5 (1988): 832-833.
  2. ↑ Spence, L. D., et al. "Rice body formation in bicipito-radial bursitis: ultrasound, CT, and MRI findings." Skeletal radiology 27 (1998): 30-32.
  3. ↑ Malanga, Gerard, and Kenneth Mautner. Atlas of ultrasound-guided musculoskeletal injections. McGraw-Hill, 2014.
  4. ↑ Ruangchaijatuporn, Thumanoon, et al. "Ultrasound evaluation of bursae: anatomy and pathological appearances." Skeletal radiology 46 (2017): 445-462.
  5. ↑ Kegels, Lore, et al. "Bicipitoradial bursitis." Acta orthopaedica belgica 72 (2006): 362-365.
  6. ↑ Nishida, Jun, et al. "Tuberculous bicipitoradial bursitis: a case report." Skeletal radiology 36 (2007): 445-448.
  7. ↑ 7.0 7.1 Tsz-Lung, Choi, and Lui Tun-Hing. "Bicipitoradial bursitis: a review of clinical presentation and treatment." Journal of Orthopaedics, Trauma and Rehabilitation 18.1 (2014): 7-11.
  8. ↑ Slouma, Maroua, et al. "Bicipitoradial bursitis: A diagnosis challenge!." Clinical Case Reports 8.11 (2020): 2265-2268.
  9. ↑ Yamamoto, Tetsuji, et al. "Bicipital radial bursitis: CT and MR appearance." Computerized medical imaging and graphics 25.6 (2001): 531-533.
Created by:
John Kiel on 31 March 2025 14:10:08
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Last edited:
31 March 2025 15:16:41
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