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Ultrasound assessment in distal biceps tendon injuries: Techniques, pearls and pitfalls

  • Zeid Al-Ani
    Correspondence
    Corresponding author at: Radiology Department, Wrightington, Wigan and Leigh NHS Foundation Trust, Royal Albert Edward Infirmary, Wigan Lane, Wigan WN1 2NN, UK.
    Affiliations
    Radiology Department, Wrightington, Wigan and Leigh NHS Foundation Trust, UK
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  • Author Footnotes
    1 Radiology Department, Wrightington, Wigan and Leigh NHS foundation Trust, Royal Albert Edward Infirmary, Wigan Lane, Wigan WN1 2NN, UK.
    Joshua Lauder
    Footnotes
    1 Radiology Department, Wrightington, Wigan and Leigh NHS foundation Trust, Royal Albert Edward Infirmary, Wigan Lane, Wigan WN1 2NN, UK.
    Affiliations
    Radiology Department, Wrightington, Wigan and Leigh NHS Foundation Trust, UK
    Search for articles by this author
  • Author Footnotes
    1 Radiology Department, Wrightington, Wigan and Leigh NHS foundation Trust, Royal Albert Edward Infirmary, Wigan Lane, Wigan WN1 2NN, UK.

      Highlights

      • The four techniques used for assessment are: the anterior, medial, lateral and posterior approaches; each having its advantages and limitations.
      • The anterior approach is useful to assess the proximal biceps tendon, the myotendinous junction and the bicipital aponeurosis.
      • The medial approach allows for transducer placement parallel to the tendon to minimize anisotropy and improve visualization.
      • The lateral approach is extremely useful in performing dynamic assessment of the distal biceps tendon, differentiating partial from complete injuries.
      • The residual stump of a completely torn distal biceps tendon might be mistaken for an intact tendon when utilizing the dorsal/posterior approach.

      Abstract

      Ultrasound assessment of the distal biceps tendon is challenging. The tendon has two components which are continuations of the long and short heads of the muscle, and these undergo 90° of rotation along their course. The tendon has a deep insertion to the radial tuberosity. Therefore, a combination of approaches and examination techniques are utilized to ensure complete evaluation. The various ultrasound approaches used to assess the distal biceps tendon, with their advantages and limitations, will be described. Selected examples of distal biceps tendon injuries, with magnetic resonance imaging (MRI) correlation in challenging cases, will be demonstrated.

      Keywords

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