Ultrasound-Guided Percutaneous Tendon Dry Needling for Recalcitrant Distal Biceps Tendinopathy: A Case Series
6 affiliations
- 1Macon Rehabilitation and Performance Center.
- 2Biology Department Mercer University.
- 3American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy.
- 4Montgomery Osteopractic Physical Therapy & Acupuncture.
- 5American Academy of Manipulative Therapy Fellowship in Musculoskeletal Ultrasonography.
- 6Tybee Wellness & Osteopractic.
Abstract
Background
Distal biceps brachii insertional tendinopathy occurs in approximately 2.6 per 100,000 individuals per year, more commonly affecting middle-aged males. Dry needling with percutaneous tendon fenestration is a common treatment for insertional tendinopathies. However, little evidence supports this treatment for the distal biceps tendon, likely secondary to difficult access without ultrasound guidance. This case series describes the treatment of two subjects with chronic distal biceps tendinopathy using ultrasound-guided percutaneous tendon dry needling with fenestration and a graded loading program in outpatient physical therapy.Study design
Case series.Methods
Two recreationally active adults with chronic distal biceps tendon pathology underwent clinical and sonographic examination, with images reviewed by clinicians registered in musculoskeletal sonography (RMSK). Subject A (55 years of age) presented with a partial distal biceps tendon tear, and Subject B (46 years of age) presented with distal biceps tendinosis. Both had pain and exercise-related functional limitations, and each participated in a physical therapy plan of care consisting of one visit per week for five weeks, including ultrasound-guided tendon dry needling for the first three weeks and graded isotonic loading of the distal biceps tendon throughout. Each subject transitioned to a guided home exercise program and was reassessed 3 and 6 months from the evaluation date. Subject-reported outcome measures included the Numeric Pain Rating Scale (NPRS), the Upper Extremity Functional Index (UEFI-20), and the Global Rating of Change (GROC) at baseline, 5 weeks, 3 months, and 6 months.Results
At five weeks, both subjects exceeded the minimal clinically important difference for each outcome measure. These results persisted at six months, with notable tendon healing characteristics visualized with diagnostic ultrasound.Conclusions
Percutaneous ultrasound-guided tendon dry needling with fenestration as an adjunct to a graded tendon loading program may have contributed to reduced pain and disability among two individuals with distal biceps tendinopathy.Level of evidence
4.
Related
- Multidimensional institutional learning curve of ultrasound-guided percutaneous transthoracic lung biopsy: a cumulative sum analysis with case-mix assessment
- Ultrasound-guided percutaneous fine-needle aspiration in parapharyngeal space lesions: a critical appraisal with illustrative cases
- Ultra-low contrast intravascular ultrasound-guided percutaneous coronary intervention of the left main and left anterior descending artery in advanced chronic kidney disease
- Intravascular imaging-guided versus angiography-guided percutaneous coronary intervention: a reconstructed individual participant data meta-analysis of randomized controlled trials of intravascular ultrasound- and optical coherence tomography-guided strategies
- Comparative Outcomes of Ultrasound-Guided Versus Fluoroscopy-Guided Percutaneous Transhepatic Biliary Drainage (PTBD) Due to Malignant Obstructive Jaundice: A Single-Center Retrospective Analysis.
BibTeX
@article{granger2026ultrasoundguided,
title = {{Ultrasound-Guided Percutaneous Tendon Dry Needling for Recalcitrant Distal Biceps Tendinopathy: A Case Series}},
author = {Austin Granger and James Dunning and James Escaloni and Ian Young},
journal = {International journal of sports physical therapy},
year = {2026},
month = nov,
doi = {10.26603/001c.172557},
url = {https://europepmc.org/article/PMC/PMC13727011},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Ultrasound-Guided Percutaneous Tendon Dry Needling for Recalcitrant Distal Biceps Tendinopathy: A Case Series
AU - Austin Granger
AU - James Dunning
AU - James Escaloni
AU - Ian Young
PY - 2026
DA - 2026/11/01
JO - International journal of sports physical therapy
DO - 10.26603/001c.172557
UR - https://europepmc.org/article/PMC/PMC13727011
AB - Background Distal biceps brachii insertional tendinopathy occurs in approximately 2.6 per 100,000 individuals per year, more commonly affecting middle-aged males. Dry needling with percutaneous tendon fenestration is a common treatment for insertional tendinopathies. However, little evidence supports this treatment for the distal biceps tendon, likely secondary to difficult access without ultrasound guidance. This case series describes the treatment of two subjects with chronic distal biceps tendinopathy using ultrasound-guided percutaneous tendon dry needling with fenestration and a graded loading program in outpatient physical therapy.Study design Case series.Methods Two recreationally active adults with chronic distal biceps tendon pathology underwent clinical and sonographic examination, with images reviewed by clinicians registered in musculoskeletal sonography (RMSK). Subject A (55 years of age) presented with a partial distal biceps tendon tear, and Subject B (46 years of age) presented with distal biceps tendinosis. Both had pain and exercise-related functional limitations, and each participated in a physical therapy plan of care consisting of one visit per week for five weeks, including ultrasound-guided tendon dry needling for the first three weeks and graded isotonic loading of the distal biceps tendon throughout. Each subject transitioned to a guided home exercise program and was reassessed 3 and 6 months from the evaluation date. Subject-reported outcome measures included the Numeric Pain Rating Scale (NPRS), the Upper Extremity Functional Index (UEFI-20), and the Global Rating of Change (GROC) at baseline, 5 weeks, 3 months, and 6 months.Results At five weeks, both subjects exceeded the minimal clinically important difference for each outcome measure. These results persisted at six months, with notable tendon healing characteristics visualized with diagnostic ultrasound.Conclusions Percutaneous ultrasound-guided tendon dry needling with fenestration as an adjunct to a graded tendon loading program may have contributed to reduced pain and disability among two individuals with distal biceps tendinopathy.Level of evidence 4.
SN - 2159-2896
ER -