Bicipitoradial bursitis and biceps tendinitis: Repetitive use versus rheumatoid arthritis

Abstract

Bicipitoradial bursitis (BRB) is the inflammation of the bicipitoradial bursa, a bursa located in the cubital fossa between the biceps tendon and radial tuberosity. It is a relatively uncommon condition mostly attributed to repetitive use; however, it can be associated with other conditions, including rheumatoid arthritis (RA). We present a 52-year-old woman who presented with novel joint pain with swelling lasting 2 months with elevated rheumatoid factor (RF) 246.2 IU/mL and anti-cyclic citrullinated peptide (CCP) antibodies >1200 IU/mL, highly suggestive of RA. It should be noted the patient works as a butcher, with earlier conditions, including carpal tunnel syndrome (CTS) which was operated on. The patient also had numbness of the right hand with electromyoneurography (EMNG) suggestive of CTS relapse and noticed swelling of the cubital fossae. As a part of the workup, a right elbow ultrasound was done showing a mass, which was confirmed by magnetic resonance imaging as BRB. Given the clinical picture, elevated RF and anti-CCP antibodies, and BRB, it was concluded that the patient likely has early RA, and BRB as a result of both repetitive use in combination with the early RA onset which possibly exacerbated an earlier, stable condition. BRB can be large enough to compress local neural structures causing symptoms, which may be an explanation for the EMNG result of CTS relapse, possibly caused by BRB instead as CTS relapse is relatively uncommon. Although a rare condition usually attributed to repetitive use, BRB can also be associated with other conditions including RA as in our case.