Exercise for biceps tendonitis should be challenging, but not painful. Normally a biceps or tenodesis is performed either via arthroscopic or open incisions. Diagnosis and determination of a plan of care is important early on if surgical treatment is necessary. Rest: The most important way to treat biceps tendinitis is to give your elbow a rest. It can also help improve circulation to the tendon and help facilitate healing. Your condition may take a bit longer if it is severe, or it may be a distant memory in only a few weeks of treatment. Biceps light isotonics progressing 1 pound per week beginning at week 12 weeks post-op. Atraumatic, insidious onset of anterior shoulder pain, Symptom exacerbation with overhead activities, Pain radiating down the anterior arm from the shoulder, Clicking or audible popping can be reported in the setting of proximal biceps instability, History or current sports, especially baseball, volleyball, and other overhead sports, History or current manual/physical laborer occupations, Superior labrum anterior-posterior lesions, Tendon sheath swelling (transverse view: for women 4.6, for men 5.5!mm;longitudinal view: for women 2.5, for men 2.8!mm, as adopted from Schmidt et al.). Shoulder Passive, Active Assisted, and Active Range of motion as tolerated all planes. Proximal bicep tendonitis: This is when there is inflammation. distal biceps tendon rupture represents about 10% of biceps ruptures. Listed below are physical therapy (PT) protocols categorized by physician. Multiple techniques exist for tenodesis, including bone tunnels, keyhole technique, suture anchors, and interference screw fixation. The biceps muscle is a muscle located in the front part of the upper arm and attaches at the elbow at one end and at two places at the shoulder. In the early stages of the disease, the LHB tendon remains mobile in the bicipital groove. Proximal biceps tendon tendinitis may be a grade 1 or 2 strain of the . Youll notice a hard time twisting doorknobs or using tools like wrenches and screwdrivers. Distal Biceps Tendonitis: Causes, Symptoms & Treatment (2015) Pain Medicine An Interdisciplinary Case-Based Approach. He specializes in spinal deformity and complex spinal reconstruction. International Journal of Clinical Medicine. When the tendon is subjected to repetitive stresses, it can become irritated, swollen, and painful. Passive elbow extension exercises may be started if needed. partial distal biceps avulsion. 0 . The physical therapist must consider both the patient's subjective response to injury and the physiological mechanisms of tissue healing; both are essential in relation to a patients return to optimal performance. Patients are usually seen at 1 week post op, then at 5-6 weeks post op. Icing can also be effective. They course from two heads (hence the name "biceps") near your shoulder joint. Biz C, Vinanti GB, Rossato A, Arnaldi E, Aldegheri R. Longo UG, Loppini M, Marineo G, Khan WS, Maffulli N, Denaro V. Nho SJ, Strauss EJ, Lenart BA, Provencher MT, Mazzocca AD, Verma NN, Romeo AA. Everyone likes to have nice, toned arms. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. 2009; 39(2): 55-70. 1173185, Pathological Process - Tendinopathic Cascade. But over time, it can cause pain, loss of strength, and difficulty flexing your elbow. Apply ice to the injury for 10-20 minutes, 3 times a day, for the first 3 days. To serve as a guide to physical therapy following your surgery, this section contains rehabilitation protocols specific to your procedure. But tendons arent so lucky. Ice may be used in the treatment of biceps tendonitis. fC|0Q QiE4.a!*WLzin%IR8o^"!Z;"ith[QI f f.$ _Oq#RBb{WTO9DqD+sxH'2l;LS('qk>@&-J>;!<7S /~r>Yt?Oy R4Qq>(+`>Q^_Cn%iQ_5mAKAuctSC%O2;pPoNl6`lGvY'#Fk7+bfN|3GR-1go!NgCe- 23"3gDUOrXTiz^/eM5 baJ;=dx!0h!ZfN58. (2008) Essentials Of Strength Training And Conditioning. The biceps also play a very important role in rotating your forearm during activities such as turning a screwdriver or doorknob. Rehabilitation Guidelines for Biceps Tenodesis This protocol is intended to guide clinicians through the post-operative course for biceps tenodesis. LHB tendon instability/dislocation (seen in association with subscapularis injuries/tears). Most commonly, LHB tendinopathy occurs in association with RC pathology, EI/SIS, or in tandem with subscapularis injuries. The resultant increased pressure and specific sites of traction predispose the tendon to pathologic shear forces. If you have pain in your upper arm or shoulder, you may have irritated your biceps tendon, a condition known as biceps tendonitis. Rehab Protocols | Physical Therapy Chicago, IL | Occupational Therapist Rehabilitation of biceps tendon disorders in athletes. Distal Biceps Repair Rehab - Adam Watson Orthopaedic Surgeon Shoulder Theraband strengthening exercises are started. Eccentrics are also able to promote healing of tendons and so I recommend sprinkling them throughout your regular workout routine. BayCare Clinic is a joint partner in Aurora BayCare Medical Center, a 167-bed, full-service hospital. Distal Biceps Tendon . Mcdevitt AW, Snodgrass SJ, Cleland JA, Leibold MBR, Krause LA, Mintken PE. As a preface to discussion of the goals of treatment during injury rehabilitation, two points must be made: Biceps tendinopathy is an inflammation that can be caused by the normal ageing process as well by a degenerative process which usually occurs in athletes with repetitive overhead movements. Larson Sports & Orthopaedics. It is the responsibility of the physical therapist to establish these guidelines. Be sure the heat does not burn your skin; a few layers of toweling should be placed between the hot pack and your skin. A sling or cuff and collar may be used for the splint or hinged brace respectively. It is by no means intended to be a substitute for one's clinical decision making . The biceps tendon is one of the anchor points of the biceps muscle, which is important for bending the elbow and rotating the wrist. %%EOF Your biceps muscles are located in the front of your upper arms. The short head of the biceps arises from the coracoid process of your shoulder blade. Biceps Tendonitis Exercises: Relieve Pain - healthline.com )Ed#. endobj It should be noted that the initial injury and inflammation of the biceps tendon is called tendonitis. Passive flexion may be increases to full. re^ 9W,F^.?Vez1`+^;qvfB\>9ek7x9V+S\yqXX5T|RMkC|R;sbZ9 }&lzDJzb7A;tWj$P mn(UqhrRx:ixv qvw`?IV]OU;gR4\2`Zxr+Q6 } |(IIi[B2I6V"^YvC7 EdL}:bcwS79EQB57\Gx0r02gCbKi#`yQVYxOK,=qf8K Stuart Hershman, MD, is a board-certified spine surgeon. Anti-inflammatories: Ibuprofen or turmeric can help relieve the pain as well. Biceps/Triceps tendon injuries. A word of caution: K-tape is a newer treatment in PT and has not been proven to be effective in the treatment of tendon disorders. Hip Replacement for Residual Hip Dysplasia, Long Head of Biceps Pathology (at shoulder), Shoulder Arthritis and Total Shoulder Replacement, Chronic Compartment Syndrome Fasciotomy Rehab Protocol, Rotator Cuff Repair, including Subscapularis, Rehab, Shoulder Instability Bankart Repair Rehab, For the first post op week, the patient is in a posterior splint that is not to be removed. Treatment of individuals with chronic bicipital tendinopathy using dry needling, eccentric-concentric exercise and stretching; a case series. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Larson Sports and Orthopedics is a group made of a surgeon, athletic trainer, and experienced HIIT Coaches who specialize in orthopedic sports medicine including anatomy and physiology, injury prevention, and orthopedic surgery/rehabilitation. Massage may also improve tissue mobility, allowing your shoulder and arm to move more freely. zy6 >E/{xT D:L=3=tCk,&S 8}f"k)7nlVanCH1XtRN$-8u7S8+BsfF/ g 4Q\wHmMd0(jIn61N(0.M0L^>. 8 Week Functional Test (Following ACL Reconstruction), 12/16 Week Functional Test (Following ACL Reconstruction), Anterior and Posterior Capsular Shift and Superior Labral Repair Protocol, Anterior Capsular Shift/Bankart-Type Repair Protocol, Brostrom Lateral Collateral Ligament Reconstruction Protocol, Medial Patellafemoral Ligament Reconstruction Protocol, Posterior Capsular Shift and Posterior Labral Repair Protocol, Small/Medium Rotator Cuff Repair Protocol. *>c~%Is/c0.dLyP"Yydvl$8QZ ;1jD9H.oC~;,k^eMS={$I38Pm%.y{q![lt}Iwno6!VSnE&1$M> mO|@'$xJ!& IFzW8E=YoiX{IY,F2z2,$?rPO!Pp{-U[oNHM9wldb Tears of the biceps tendon at the elbow are uncommon, occurring in only 3 to 5 people per 100,000 each year, and rarely in women. Demographics. He also holds a CF-L1 certificate and is a Certified BFR Specialist. It is based in Green Bay, Wisconsin. Raise your injured arm out to your side and place the thumb side of your hand against the wall (palm down). 3 0 obj Quantitative diagnostic method for biceps long head tendinitis by using ultrasound. Dr. James Larson is an orthopedic surgeon specializing in sports medicine and arthroscopic surgery. Physical Therapist's Guide to Biceps Tendon Rupture Other more invasive treatments for persistent biceps tendonitis may include cortisone injections, platelet rich plasma injections, or surgery. Electircal stimulation may be used to help treat your biceps tendonitis or tendinopathy. Save my name, email, and website in this browser for the next time I comment. The Most Common Causes Of Elbow Pain While Lifting. 4 0 obj Protection & Education Time Frame 0 to 6 weeks post procedure Key Goals Protection of surgical repair Minimise pain & inflammation Ensure patient understanding of appropriate post-operative management and restrictions Regain ROM Distal Biceps Tendonitis | Upswing Health Putty may be used 3 times per day to improve grip strength. Surgical: If conservative management has not been successful then surgical management can be considered. Physical Therapy Protocols - Brigham And Women's Faulkner Hospital In 1982, Neviaser et al. The biceps muscle helps to decelerate your elbow as it is extending, and overusing it in repetition may place excessive stress on the tendon, leading to inflammation. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Often, physical therapy may be prescribed. J shoulder Elbow Surg March 5, 2020. needs to learn more about biceps tenodesis and rehabilitation we recommend reading: Krupp RJ. But biceps tendonitis is one of several possible causes of pain around the elbow. https://www.youtube.com/watch?v=j4vYM7JXSW8, Diagnosis and treatment of biceps tendinitis and tendinosis, The shoulder in baseball pitching: biomechanics and related injuries--Part 1, The long head of biceps and associated tendinopathy. K(-fr If your PT chooses to use e-stim for your biceps tendonitis, two to four small electrodes will be placed around your shoulder and upper arm, and electricity will be applied to the electrodes. Tendinopathy of the biceps can be painless early on. hb```@(Q`CG6*:Q In the setting of RC tears, 90% of cases demonstrated concomitant LHB tendinopathy, and 45% of cases had additional LHB instability[1], The pathophysiology of LHB tendinitis/tendinopathy begins with. 2010 Apr;29(2):229- 46, vii-viii. Most cases can be treated successfully in about four to six weeks. Guide | Physical Therapy Guide to Biceps Tendinitis | Choose PT 4 0 obj Distal Bicep Tendon Repair Protocol - Northwestern Medical Center In effect, the tendon becomes pathologically anchored in the groove, further exacerbating the potential points of traction and overall increasing shear forces experienced by the LHB tendon along its course. While the function of your biceps is to turn your forearm into a palm-up position, it also works to help move your shoulder joint and assists the rotator cuff muscle group in stabilizing the front of your shoulder. Surgery is typically performed through an open incision in the front of the elbow or through a two-incision approach, with a small incision in both the front and the back of the elbow. Care should be used, since ice placed directly on your skin may cause a frost burn. It is theorized that this type of contraction remodels the collagen that makes up the tendon, helping it to heal properly. A biceps tendon rupture occurs when the biceps muscle is torn from the bone at the point of attachment (tendon) to the shoulder or elbow. The patient must meet specific objectives to progress from one phase of healing to the next. Forearm twists help keep your arm flexible and help your tendon glide smoothly along the biceps muscle. PDF Rehabilitation Guidelines for Biceps Tenodesis Distal Biceps Rupture - Physical Therapy in Baton Rouge Prone T, Y, and W. Shoulder extension with T-band. Distal Biceps Tendinopathy: Prevention and Treatment Other elbow conditions: Common elbow, hand, and wrist conditions Tennis elbow He started LSO to keep more people moving better, longer. Our doctors also perform surgeries at APEX Surgical Center. Please note these are meant to be guidelines for rehabilitation to be followed by a certified physical or occupational therapist. Main outcome measures of biceps tendinopathy are: Conservative: Initial treatment should consist of pain management and use of NSAIDs. Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. [3] Thats why distal biceps tendinopathy is one of the most common causes of elbow pain in lifters and athletes. There are several muscles that help with both of these. This electrical impulse may tickle a bit, but it should not cause pain. If this is unsuccessful the use of steroid injections may be helpful in managing pain. As the pathophysiology escalates, there is an ensuing LHB sheath thickening, fibrosis, and vascular compromise. Tears occur secondary to unexpected extension forces and are typically associated with a "pop". Improve Your Core Control: As Ive discussed in other articles, core strength and control are extremely important in preventing extremity injuries. <> Add Eccentrics: Eccentric exercise actually lengthens your muscles and decreases the risk of tendinitis. The patient will primarily experience pain localised in the bicipital groove and may radiate toward the insertion of the deltoid muscle, or down to the hand in radial distribution. Dr. Awowale ACL Reconstruction ACL Reconstruction with Meniscus Repair or Microfracture Distal Biceps Repair Hip Arthroscopy Rotator Cuff Repair Protocol SLAP Repair, Bankart Repair, or Biceps Tenodesis Total Shoulder or Reverse Arthroplasty Protocol Dr. DeVries He supports weight training and high-intensity exercise throughout the lifespan. Biceps Tenodesis Rehab Protocol - Houston, TX & Baytown, TX: David hbbd```b``z"WIGbfkem$/d l/0,r>&p$'W[20m @g`` 33 Heat can also be used to decrease pain and improve tissue mobility. Hold 15 seconds. Your physical therapist may apply heat to your upper arm and shoulder if you have biceps tendonitis. Biceps Tendon Strengthening Exercises | Advanced Sports & Spine endobj These may include: If you suspect you have biceps tendonitis, you should visit your healthcare provider right away to get a diagnosis. This can help decrease pain and improve localized circulation. <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Suns Out, Guns Out! It is attached to the bones of the shoulder and elbow by tendons strong cords of fibrous tissue that attach muscles to bones. RICE therapy (rest, ice, compression, elevation) may reduce the severity of symptoms. It commonly occurs in the dominant extremity of middle-aged men during an excessive eccentric tension as the arm is forced from a flexed . % Many physical therapists do not use ultrasound due to this lack of benefit. Copyright 2023. 2012;2012:405472. ACL Reconstruction with Meniscus Repair or Microfracture, SLAP Repair, Bankart Repair, or Biceps Tenodesis, Total Shoulder or Reverse Arthroplasty Protocol, Non-Operative Achilles Tendon Rupture Protocol, ACI ProcedureACL Reconstruction Rehabilitation ProtocolAMZ ProcedureHip Arthroscopy Rehabilitation ProtocolMeniscus TransplantationMeniscal Repair ProtocolMicrofracture ProcedureMPFL Repair Reconstruction ProtocolOATS Procedure Patella Femoral ArthroplastyFemoral Acetabular, Distal Radius Fracture Post Surgical Volar Plating, ECRB or FDS to Lateral Band Tendon Transfer for Clawing, Flexor Tendon Zones 1-3 Early Mobilization, Flexor Tendon Zones 1-4 Delayed Mobilization, Pin Site Care Post-Operative Instructions, Scaphoid Fracture Post-Operative Management, Achilles Tendon RepairACL ReconstructionAnkle SprainAnkle Sprain SevereAnterior Interval Release - KneeArthroscopic Ankle DebridementArthroscopic Ankle with MFXBankart Repair or Anterior or Posterior Labral RepairBrostrom ProcedureBrostrom with MFX ProcedureDistal Biceps RepairElbow DebridementElbow Radial Collateral RepairProximal Hamstring Tendon RepairHigh Tibial OsteotomyLateral EpicondyleLateral Epicondyle Fascial ReleaseLateral Release - Knee Lateral Release with Meniscus RepairLCL ReconstructionMCL Repair ProtocolMedial EpicondyleMedial Patellofemoral Ligament Repair/ReconstructionMedial ReefingMeniscus RepairMicrofracture Femoral CondyleMicrofracture Trochlear Grove PatellaMUA - KneePatellar Tendon FenestrationPatellar Tendon RepairPCL ReconstructionQuadriceps Tendon RepairRotator Cuff Repair Rehabilitation ProtocolShoulder StabilizationTibial Plateau FractureTibial Tubercle TransferUCL Reconstruction, Achilles Tendon Ultrasound Guided Percutaneous Tenotomy, Gluteal Tendon Ultrasound Guided Percutaneous Tenotomy, Hamstring Tendons Ultrasound Guided Percutaneous Tenotomy, Patellar - Quadriceps Tendon Ultrasound Guided Percutaneous Tenotomy, Plantar Fascia Ultrasound Guided Percutaneous Fasciotomy, Ultrasound Guided Percutaneous Elbow Tenotomy, Ultrasound Guided Percutaneous Shoulder Tenotomy. Other associated shoulder pathologies include: Primary LHB tendinitis represents about 5% of cases of proximal biceps pathology. Tendon sheath fluid accumulation (abnormal hypoechoic or anechoic accumulation relative to the subdermal fat, although occasionally this could be isoechoic or hyperechoic) in intraarticular material that is displaceable and compressible and 3!mm, as adopted from Bruyn etal. <> Distal Biceps Tendon Injury: An Overview - HSS.edu Leading to an increase in pain on pull, push and overhead motions. Long head of the biceps pathology combined with rotator cuff tears. The stimulation, or e-stim, can be used to decrease pain, improve muscle function, or increase circulation. You may also do this next to a wall and rest your fingers on the wall. If you have pain in the front of your elbow when lifting, in the little hollow, it could be distal biceps tendinopathy. Kevern MA. Of the thousands of people treated every year, many are children, adults and senior citizens who have chosen Hamilton Orthopaedics, Spine and Sports Medicine as the best place to give them the most advanced orthopaedic care. They can also help you to correct any muscle imbalances or problems with your form to prevent recurrent injury. Surgical Bankart & Anterior Labral Repair. The vast majority of cases are seen in association with the aforementioned shoulder pathologies. %PDF-1.7 Successful physical therapy regimens target the underlying source(s) contributing to the LHB tendon pathology. The biceps tendon, the tendon associated with the biceps muscle, is made up of 2 parts: the long head and the short head. If the pain caused by tendonitis or bursitis continues despite more conservative treatment options such as physical therapy, surgery may be the most effective option. Biceps tenodesis has traditionally been performed through the deltopectoral interval to visualize the retracted tendon distally in the groove. Still, some therapists use it, and you may encounter it when being treated for your biceps tendonitis. Be sure you understand what to expect from iontophoresis, and speak with your physical therapist if you have any questions about it. doi: 10.1016/j.csm.2009.12.003 . Anatomic location. Distal Biceps Repair Rehab Postoperative Distal Biceps Tendon Repair Rehabilitation Protocol PHASE I: 1-3 WEEKS For the first post op week, the patient is in a posterior splint that is not to be removed. This protocol is time . Stand and hold your affected arm out to the side, with your hand at about hip level. OUP USA. Treatment for tendonitis & bursitis | TRIA Orthopedics - HealthPartners While you're dealing with pain from an inflamed bicep tendon, fill an ice pack with ice and hold it against the area that's hurting for up to 20 minutes. It's a sign of overuse and your body is telling you that it needs a rest. Exercises that work your biceps include curls, reverse curls, rowing, pull-ups, rope climb, and Olympic lifts. Biceps Tendon Injury Exercises: References. Golfers Elbow Braces and Rehab Equipment, Bulging, shortened appearance of the biceps. This is usually felt as a pop or tearing sensation in the front of the elbow and usually really painful. Bicep Tendon Tear - Physiotherapy Treatment Posterior splint at 90 degrees of elbow flexion. Biceps tendinitis occurs when there's inflammation of the biceps tendon. When a direct current that is also negatively charged is applied to the medicine, it repels it, driving the drug into your tendon. May continue bicep curls progressively add resistance. First 7 - 10 days. The biceps muscle has 2 tendons that attach it to the shoulder and travel the length of the upper arm and insert just below the elbow. During tissue healing, controlled therapeutic stress is necessary to optimize. So be sure to check with your coach or trainer if you develop tendinitis of any kind. The most common surgery for bursitis is a bursectomy, which removes the inflamed bursa to help relieve pain and promote healing. Surgery should be considered if conservative measures fail after three months. Rubinger et al. 191 0 obj <>/Filter/FlateDecode/ID[<96B5A7559837E940A76D1930163689E3>]/Index[172 28]/Info 171 0 R/Length 96/Prev 212290/Root 173 0 R/Size 200/Type/XRef/W[1 3 1]>>stream But that takes a lot of work. Distal biceps tendinopathy can also be known as distal biceps tendinosis or distal biceps tendinitis. 'mn_~TZW2n^jrP" /bPR"JQlr%V/FZv Tendon pathology and subsequent rehabilitation will vary considerably depending on the site of pathology; stage of the tendinopathy; functional assessment; activity status of the person; contributing issues throughout the kinetic chain; comorbidities; and concurrent presentations [4]. This tendon stretches along your biceps muscle from your elbow up to your shoulder. Heat and Ice: Ice can help reduce the pain, but heat is typically better to improve blood flow and help speed healing. ntYDSp6t^=p. Use free movement to tolerance; adopting the overhead position for rehabilitation NOTE: The elbow is a very proprioceptive vacant joint and therefore overhead positional rehabilitation using visual feedback can be very useful as well as using a tubigrip to aid with tactile feedback and improve proprioception. Biceps Tendonitis Physical Therapy and Rehab - Verywell Health PDF Biceps Tenodesis Protocol - Boston Shoulder Institute Immobilization in Splint with Elbow at 90 of flexion; Encourage digital , shoulder ROM; Elevation; Pain Control; Phase 1 (1 week to 6 weeks) Elbow immobilized in flexion-assisted Bledsoe brace with extension stop at 30 Gentle supervised passive ROM (active extension) from 30 . The team of compassionate, highly renowned orthopedic surgeons and specialists at Hamilton Orthopedics, Spine & Sports Medicine are dedicated to providing patients with the most advanced orthopedic care in sports medicine, reconstructive surgery, total joint replacements and revisions, treatment of spinal cord injuries and diseases, on-site x-ray and casting, on-site physical therapy and rehabilitation, and arthroscopic rotator cuff repair. This may start with isometric training if pain is the primary issue progressing into eccentric training and eventually concentric loading as with other forms of tendon rehab. But the biceps is a pretty important one. Its a sign of overuse and your body is telling you that it needs a rest. When a rotator cuff muscle is torn, your biceps tendon may overwork to help stabilize the area, leading to biceps tendonitis. Distal Bicep Tendon Repair Protocol . Distal bicep tendonitis is a common cause of elbow pain in gym-goers. Distal Biceps Tendinopathy: Prevention and Treatment. The present study was designed to assess the outcomes associated with unrepaired distal biceps tendon ruptures. Gently bend your wrist back so that your fingers point down toward the floor. Best Exercises for Biceps Tendonitis - WebMD Biceps stretch. Conservative Posterior Instability. Surgical management of biceps tendinitis includes removing the long head of the biceps tendon via arthroscopic tenodesis. Biceps Tendon Injuries: Causes, Symptoms & Treatments - Cleveland Clinic Notify your therapist if you feel discomfort during ice use in the PT clinic. Applicability: Physician Practices Date Effective: 09/2013 Department: Rehabilitation Services Date Last Reviewed: 1/2021 . "B/_|`+BOxIQyD0r>}wKO_2{}_m_yg=^,wm~\,L) MM&"$^t)^k!Z_u Surgical Biceps Tenodesis. If these simple steps are ineffective, other treatments such as cortisone injections, needle tenotomy, or PRP injections are possible. Iontophoresis is a special form of electrical stimulation that uses electricity to administer medication through your skin and into your injured biceps tendon. D`^l(=/t Shoulder rotator cuff and scapular strengthening. The biceps and triceps muscles are the major flexors (biceps) and extensors (triceps) of the arm at the elbow joint. Gaines MD.