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DOI: 10.1148/rg.255045160
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Right arrow Magnetic Resonance Imaging
Right arrow Musculoskeletal Radiology

Disorders of the Distal Biceps Brachii Tendon1

Michael L. Chew, MBBS, BA and Bruno M. Giuffrè, MBBS, FRANZCR

1 From the Radiology Department, Royal North Shore Hospital, St Leonards, NSW 2065 Australia. Presented as an education exhibit at the 2003 RSNA Annual Meeting. Received August 25, 2004; revision requested October 5 and received December 8; accepted December 9. All authors have no financial relationships to disclose.


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  		Figure 1.  Drawing (cubital fossa dissection) illustrates the biceps tendon and adjacent structures. (Reprinted, with permission, from reference 1.)

 


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  		Figure 2.  Photograph illustrates the FABS position. (Reprinted, with permission, from reference 4.)

 


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  		Figure 3.  Localization image shows a FABS view with planned sections oriented perpendicular to the radial shaft. (Reprinted, with permission, from reference 4.)

 


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  		Figure 4.  Fast spin-echo proton-density–weighted MR image (repetition time msec/echo time msec = 3000/34) obtained with the patient in the FABS position shows a normal distal biceps tendon (curved arrow), the musculotendinous junction (straight arrow), and the radial tuberosity (arrowhead). (Reprinted, with permission, from reference 4.)

 


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  		Figure 5.  Fat-suppressed fast spin-echo proton-density–weighted MR image (3000/45) demonstrates a minor partial tear of the distal biceps tendon (arrow) with a trace of peritendinous fluid (arrowhead). (Reprinted, with permission, from reference 4.)

 


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  		Figure 6.  Photograph illustrates the scanning technique for obtaining a longitudinal US image from the volar surface of the left arm.

 


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  		Figure 7a.  Longitudinal (a) and transverse (b) US images show a normal distal biceps tendon (arrows).

 


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  		Figure 7b.  Longitudinal (a) and transverse (b) US images show a normal distal biceps tendon (arrows).

 


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  		Figure 8.  Transverse US image obtained from the volar aspect of the arm shows a normal distal biceps tendon. Note that the tendon is visible to its insertion site on the radial tuberosity (arrows).

 


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  		Figure 9.  Photograph illustrates the scanning technique for obtaining a transverse US image of the pronated arm from the dorsal aspect. (Reprinted, with permission, from reference 5.)

 


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  		Figure 10a.  US images obtained from the dorsal aspect with the arm in supination (a) and pronation (b) show the distal insertion site of the biceps tendon (arrows in b). Note that in supination the radial tuberosity is not seen, whereas in pronation it lies close to the probe. (Reprinted, with permission, from reference 5.)

 


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  		Figure 10b.  US images obtained from the dorsal aspect with the arm in supination (a) and pronation (b) show the distal insertion site of the biceps tendon (arrows in b). Note that in supination the radial tuberosity is not seen, whereas in pronation it lies close to the probe. (Reprinted, with permission, from reference 5.)

 


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  		Figure 11a.  FABS fat-suppressed (a) and axial (b) fast spin-echo proton-density–weighted MR images show a complete tear of the distal biceps tendon. Note the thickened proximal part of the tendon (long arrow in a) and the discontinuity starting 2 cm proximal to the radial tuberosity (short arrow in a). Note also the nonvisualization of the tendon close to its insertion site (arrow in b).

 


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  		Figure 11b.  FABS fat-suppressed (a) and axial (b) fast spin-echo proton-density–weighted MR images show a complete tear of the distal biceps tendon. Note the thickened proximal part of the tendon (long arrow in a) and the discontinuity starting 2 cm proximal to the radial tuberosity (short arrow in a). Note also the nonvisualization of the tendon close to its insertion site (arrow in b).

 


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  		Figure 12a.  FABS (a) and axial (b) fast spin-echo proton-density–weighted MR images demonstrate a complete tear of the distal biceps tendon with an intact bicipital aponeurosis (arrowhead in b). Note that the aponeurosis extends from an enlarged proximal tendon (arrow).

 


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  		Figure 12b.  FABS (a) and axial (b) fast spin-echo proton-density–weighted MR images demonstrate a complete tear of the distal biceps tendon with an intact bicipital aponeurosis (arrowhead in b). Note that the aponeurosis extends from an enlarged proximal tendon (arrow).

 


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  		Figure 13a.  FABS (a) and sagittal (b, c) fast spin-echo proton-density–weighted MR images show a minor partial tear of the distal biceps tendon. Arrow in a, black arrow in b, and arrow in c indicate the tendon; white arrow in b indicates the radial tuberosity. Note the partial volume averaging effect in b and c, which makes confident diagnosis difficult on sagittal views. However, the intratendinous signal intensity and peritendinous fluid seen on the FABS view tend to help confirm the diagnosis of a minor partial tear.

 


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  		Figure 13b.  FABS (a) and sagittal (b, c) fast spin-echo proton-density–weighted MR images show a minor partial tear of the distal biceps tendon. Arrow in a, black arrow in b, and arrow in c indicate the tendon; white arrow in b indicates the radial tuberosity. Note the partial volume averaging effect in b and c, which makes confident diagnosis difficult on sagittal views. However, the intratendinous signal intensity and peritendinous fluid seen on the FABS view tend to help confirm the diagnosis of a minor partial tear.

 


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  		Figure 13c.  FABS (a) and sagittal (b, c) fast spin-echo proton-density–weighted MR images show a minor partial tear of the distal biceps tendon. Arrow in a, black arrow in b, and arrow in c indicate the tendon; white arrow in b indicates the radial tuberosity. Note the partial volume averaging effect in b and c, which makes confident diagnosis difficult on sagittal views. However, the intratendinous signal intensity and peritendinous fluid seen on the FABS view tend to help confirm the diagnosis of a minor partial tear.

 


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  		Figure 14a.  Axial (a) and FABS fat-suppressed (b) fast spin-echo proton-density–weighted MR images show a minor partial tear of the distal biceps tendon close to its insertion site on the radial tuberosity. Note the abnormal intratendinous signal intensity of the tear (arrow).

 


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  		Figure 14b.  Axial (a) and FABS fat-suppressed (b) fast spin-echo proton-density–weighted MR images show a minor partial tear of the distal biceps tendon close to its insertion site on the radial tuberosity. Note the abnormal intratendinous signal intensity of the tear (arrow).

 


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  		Figure 15a.  (a, b) Longitudinal (a) and transverse (b) US images show a moderate partial tear of the distal biceps tendon (arrows in a, arrowheads in b). (c, d) FABS (c) and axial (d) fast spin-echo proton-density–weighted MR images show the partial tear. Note the tendon thickening (long arrow) and the abnormal intraten-dinous signal intensity (short arrow).

 


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  		Figure 15b.  (a, b) Longitudinal (a) and transverse (b) US images show a moderate partial tear of the distal biceps tendon (arrows in a, arrowheads in b). (c, d) FABS (c) and axial (d) fast spin-echo proton-density–weighted MR images show the partial tear. Note the tendon thickening (long arrow) and the abnormal intraten-dinous signal intensity (short arrow).

 


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  		Figure 15c.  (a, b) Longitudinal (a) and transverse (b) US images show a moderate partial tear of the distal biceps tendon (arrows in a, arrowheads in b). (c, d) FABS (c) and axial (d) fast spin-echo proton-density–weighted MR images show the partial tear. Note the tendon thickening (long arrow) and the abnormal intraten-dinous signal intensity (short arrow).

 


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  		Figure 15d.  (a, b) Longitudinal (a) and transverse (b) US images show a moderate partial tear of the distal biceps tendon (arrows in a, arrowheads in b). (c, d) FABS (c) and axial (d) fast spin-echo proton-density–weighted MR images show the partial tear. Note the tendon thickening (long arrow) and the abnormal intraten-dinous signal intensity (short arrow).

 


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  		Figure 16.  Diagrams illustrate cross-sectional views of a spur at the radial tuberosity causing tendon degeneration. In pronation (A), the sharp margin of the spur impinges on the tendon. In supination (B), the tendon is no longer in contact with the spur. (Reprinted, with permission, from reference 13.)

 


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  		Figure 17a.  (a) FABS MR image obtained in a young volunteer shows a normal distal biceps tendon. (b) MR image obtained in an older asymptomatic volunteer shows a small spur at the insertion site of the tendon (arrow).

 


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  		Figure 17b.  (a) FABS MR image obtained in a young volunteer shows a normal distal biceps tendon. (b) MR image obtained in an older asymptomatic volunteer shows a small spur at the insertion site of the tendon (arrow).

 


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  		Figure 18a.  Drawings illustrate the relationship of the bursae to the nerves (a) and changes that occur as the forearm moves from supination to pronation (b). BRB = bicipitoradial bursa, BT = biceps tendon, R = radius, rt = radial tuberosity, U = ulna. (Reprinted, with permission, from reference 2.)

 


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  		Figure 18b.  Drawings illustrate the relationship of the bursae to the nerves (a) and changes that occur as the forearm moves from supination to pronation (b). BRB = bicipitoradial bursa, BT = biceps tendon, R = radius, rt = radial tuberosity, U = ulna. (Reprinted, with permission, from reference 2.)

 


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  		Figure 19a.  Axial (a) and FABS fat-suppressed (b) fast spin-echo proton-density–weighted MR images show bursitis associated with a partial tendon tear. Note the fluid collection in the bicipitoradial bursa (arrowhead), with abnormal intratendinous signal intensity in the partial tear close to the insertion site of the tendon (curved arrow in a, arrow in b). Straight solid arrow in a indicates the median nerve, open arrow in a indicates the posterior interosseous nerve.

 


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  		Figure 19b.  Axial (a) and FABS fat-suppressed (b) fast spin-echo proton-density–weighted MR images show bursitis associated with a partial tendon tear. Note the fluid collection in the bicipitoradial bursa (arrowhead), with abnormal intratendinous signal intensity in the partial tear close to the insertion site of the tendon (curved arrow in a, arrow in b). Straight solid arrow in a indicates the median nerve, open arrow in a indicates the posterior interosseous nerve.

 


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  		Figure 20.  Radiograph shows a previously repaired biceps tendon with suture anchors in place. Note the minor heterotopic bone formation (arrow).

 


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  		Figure 21.  Drawing illustrates the two-incision technique for treatment of complete rupture of the distal biceps tendon. The detached tendon is milked out through a transverse incision of the antecubital space. The tendon is then trimmed and an incision made dorsolaterally to allow exposure of the radial tuberosity, which is then excavated. Finally, the tendon is brought through the previous tract and reinserted onto the tuberosity. (Reprinted, with permission, from reference 7.)

 


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  		Figure 22.  FABS fast spin-echo proton-density–weighted MR image shows a surgically repaired tendon. Note the bone defect at the radial tuberosity (arrow) and the diffuse enlargement and abnormal signal intensity of the successfully repaired tendon (arrowheads).

 


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  		Figure 23.  Computed tomographic scan shows imaging-guided injection of a steroid and local anesthetic around the biceps tendon (arrow).

 




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