Imaging Findings

Based on the provided MRI sequence images (visible in coronal and axial views), the distal elbow joint shows the following features:

• The biceps tendon near the radial tuberosity has a discontinuity or appears incompletely visualized, suggesting a tendon tear or at least partial fiber rupture.
• A focal high-signal abnormality is seen in the distal portion of the biceps tendon, likely indicating localized edema, inflammation, or hemorrhage.
• A small amount of high signal is visible in the surrounding soft tissue, suggesting associated edema or effusion.
• No obvious bone destruction or clear fracture line is observed, but in combination with clinical symptoms at the radial tuberosity, one should remain vigilant for scarring, periosteal reaction, or minor avulsions.

Potential Diagnoses

1. Distal Biceps Tendon Tear (Complete or Partial)
   Characteristics: Common in middle-aged men, especially those who experience excessive traction during weightlifting or intense exercise. MRI may show tear, irregularity, or retraction of the tendon, accompanied by local soft tissue edema or hemorrhage.
2. Acute Strain of the Brachialis or Other Adjacent Tendons
   Characteristics: Acute injury to adjacent tendons or muscles can appear as high-signal areas, but the biceps tendon itself may remain relatively intact. Careful tracking of the tendon course helps distinguish such injuries.
3. Bursitis or Tenosynovitis
   Characteristics: Inflammatory conditions may present with mild edema or effusion in the local soft tissues, but without significant disruption of the biceps tendon’s integrity. Patients often have a history of chronic or repetitive overuse.

Final Diagnosis

Considering the patient’s age (35 years), clinical presentation (forearm pain and swelling after lifting heavy objects), and MRI findings (distal tendon discontinuity and high-signal edema), the most likely diagnosis is: Distal Biceps Tendon Tear (possibly partial to near-complete).

For further clarification of the extent, contrast-enhanced MRI or dynamic ultrasound observation can be performed. However, current clinical and imaging findings strongly suggest a distal biceps tendon injury.

Treatment Plan and Rehabilitation

For a distal biceps tendon tear, refer to the following treatment and rehabilitation options:

1. Conservative Treatment
   • Applicable for mild tears or for patients with surgical contraindications.
   • Includes bracing or protective support to reduce loading and limit range of motion.
   • Oral anti-inflammatory and analgesic medications can help alleviate local pain and inflammation.
2. Surgical Treatment
   • Recommended for severe tears or when there is significant tendon retraction.
   • The primary goal is to reattach the torn end to the radial tuberosity, restoring forearm flexion and supination function.
   • Postoperative management usually involves immobilization followed by gradual rehabilitation training.

Example Rehabilitation and Exercise Prescription (FITT-VP Principle):

• Early Stage (Postoperative or Acute Phase)
  • Frequency: 2–3 sessions per day of gentle positioning and passive movement.
  • Intensity: Limit weight-bearing, avoid significant pain or re-injury.
  • Time: 5–10 minutes per session, focusing on mild activity.
  • Type: Passive range-of-motion exercises, basic muscle activation (e.g., small-range finger and wrist movements).
  • Progression: Slowly increase range of motion based on pain and swelling.
• Intermediate Stage (After Removing Immobilization or When Inflammation Subsides)
  • Frequency: 3–4 times per week.
  • Intensity: Gradually introduce active muscle contractions and light resistance exercises.
  • Time: 15–20 minutes per session.
  • Type: Elbow flexion and forearm supination exercises with light resistance (e.g., elastic bands), progressive range-of-motion training.
  • Progression: Incrementally increase resistance by moving from light to moderate elastic bands.
• Late Stage (Functional Recovery to Strengthening Phase)
  • Frequency: 3–4 times per week.
  • Intensity: Gradually increase load safely, progressing from bodyweight exercises to light dumbbells.
  • Time: 20–30 minutes per session.
  • Type: Elbow flexion, supination, and comprehensive training of the shoulder girdle.
  • Progression: Increase to near-normal load levels based on functional recovery, while avoiding overexertion and re-injury.

Throughout the rehabilitation process, closely monitor elbow and forearm pain, swelling, and any functional changes. If significant discomfort or functional decline occurs, promptly seek evaluation or adjust the rehabilitation plan.

Disclaimer: This report is based solely on the provided information for reference and does not replace an in-person consultation or professional medical advice. If you have any doubts or if your condition changes, please consult a healthcare provider promptly.