612 - An atypical presentation of bicipitoradial bursitis with alternative treatment development using supinator tendon for sono-guided steroid injections.

Case Diagnosis: Bicipitoradial bursitis.

Case Description: 35-year-old male with a past medical history of surgical repair of right hand first metacarpophalangeal (MCP) collateral ligament secondary to rupture, who presented right forearm pain which progressed after a fall from standing height. Physical examination revealed right lateral elbow pain to palpation without numbness; no pain on lateral extensor tendon specialized tests; no edema, erythema, or deformity; intact tone and sensation; decreased strength due to pain and limited active/passive range of motion. Deep tendon reflexes were diminished bilaterally, and no other neurologic deficits were present. Patient with initial recommendations for physical and occupation therapy with limited improvement. MRI performed found bicipitoradial bursitis and accessory anconeus muscle. Due to the failure of conservative measures, steroid injection was performed resulting in decreased pain with subsequent improvement in ROM and strength.

Discussions: Typical bicipitoradial bursitis presents as a palpable mass in the antecubital region, producing pain on the extensor tendons and limiting elbow motion. It is commonly diagnosed by ultrasound imaging. Interestingly, this patient did not present with a palpable mass nor pain on the extensor tendons and had limited improvement to conservative measures. Steroid injections have been used for bursitis, especially on lower extremities such as trochanteric bursitis, and in upper extremities such as golfer’s/tennis elbow with an adequate response. However, using the supinator tendon approach is rarely used with most injections performed localizing the distal biceps tendon and radial tuberosity.

Conclusions: Bicipitoradial bursitis is a rare finding and reason for lateral elbow pain, with lateral epicondylitis being the most common. Moreover, in cases where conservative management does not improve symptoms, injection of the supinator tendon may be provided as a treatment alternative for patient relief.