What could be causing pain in my forearm when rotating and pushing open doors, with occasional radiation to my bicep?

Forearm Pain with Rotation and Door Pushing: Likely Diagnosis and Management

Your symptoms most likely represent lateral epicondylitis (tennis elbow) or distal biceps tendinopathy, both common overuse tendon injuries affecting the forearm and biceps region. 1

Most Probable Diagnoses

Lateral Epicondylitis (Tennis Elbow)

• This is the most common cause of chronic elbow and forearm pain, affecting 1-3% of the population 1
• Pain localizes to the lateral epicondyle and radiates down the forearm with gripping, twisting motions (like opening doors), and supination/pronation movements 1, 2
• Results from degenerative changes in the common extensor tendon, not acute inflammation 1
• Occupational and recreational repetitive activities are primary risk factors 1, 2

Distal Biceps Tendinopathy

• Pain radiating into the bicep strongly suggests biceps tendon involvement 1, 3
• Distal biceps pathology causes anterior elbow/forearm pain that worsens with resisted supination (rotating forearm palm-up) and elbow flexion 1, 3
• Can present as partial or complete tears, with partial tears being more common 3

Other Considerations

• Medial epicondylitis (golfer's elbow) affects the medial side but can cause similar rotational pain 1
• Repetitive strain injury from occupational overuse involving multiple soft tissue structures 2, 4, 5

Clinical Examination Findings to Confirm

Palpation will reveal well-localized tenderness that reproduces your exact pain quality and location 1:

• Lateral epicondyle tenderness = lateral epicondylitis
• Anterior elbow/proximal forearm tenderness = distal biceps involvement
• Pain with resisted wrist extension = lateral epicondylitis 1
• Pain with resisted forearm supination and elbow flexion = biceps tendinopathy 3

Look for muscle atrophy if symptoms are chronic, which indicates prolonged tendon pathology 1

Recommended Diagnostic Imaging Algorithm

Start with plain radiographs of the elbow to rule out fractures, loose bodies, osteophytes, or osteoarthritis 1, 3:

• Radiographs may show epicondylar osteophyte formation or calcific tendinosis 1
• This is the appropriate first imaging study even though soft tissue changes won't be visible 1, 3

If radiographs are normal or nonspecific and diagnosis remains unclear after 4-6 weeks of conservative treatment, proceed to MRI without contrast 1, 3:

• MRI is superior to ultrasound for biceps tendon tears (86.4% vs 45.5% accuracy) 3
• MRI demonstrates tendon thickening, degenerative changes, partial tears, and fibrovascular proliferation 1
• For suspected distal biceps pathology specifically, request the FABS view (flexion-abduction-supination) which visualizes the entire distal biceps tendon on a single image 1, 3

Ultrasound can show tendon thickening and heterogeneous echogenicity but has significant limitations for detecting partial tears 1, 3. Use ultrasound only if MRI is contraindicated 3.

Treatment Approach

Begin conservative management immediately without waiting for imaging 1, 4:

Relative Rest (Not Complete Immobilization)

• Reduce repetitive loading activities that reproduce pain (door pushing, rotational movements) 1
• Continue activities that don't worsen symptoms to prevent muscle atrophy 1
• Complete immobilization causes deconditioning and should be avoided 1

Pain Control

• Ice application to affected area 1
• NSAIDs for analgesia 1, 4
• Topical pain-relief agents 4

Rehabilitation

• Eccentric strengthening exercises are proven beneficial for tendinopathy 1
• Stretching exercises are widely accepted and helpful 1
• Physical therapy to restore flexibility and strength 1, 4

Workplace/Activity Modification

• Identify and eliminate aggravating factors including improper posture and ergonomic hazards 4, 5
• Modify repetitive motions at work that involve forceful gripping, twisting, or overhead positioning 2, 5

Refractory Cases

• Corticosteroid injections provide temporary pain relief 1, 4
• Surgery reserved for cases failing 6+ months of conservative treatment 1, 6

Critical Pitfalls to Avoid

Do not rely solely on ultrasound for diagnosis - it misses partial tears and has poor sensitivity compared to MRI 3

Do not order MRI immediately - start with plain radiographs first per ACR guidelines 1, 3

Do not prescribe complete rest - tensile loading stimulates proper collagen alignment and healing 1

Expect prolonged recovery - tendinopathy typically takes weeks to months to resolve, not days 1, 2

Rule out systemic rheumatologic disease if multiple tendons are symptomatic simultaneously 1