The Radioulnar Distance at the Level of the Radial Tuberosity

Abstract

Ruptures of the distal biceps brachii tendon are generally treated operatively due to their loss of supination and flexion force. A mechanical impingement at the insertion of the tendon at the radial tuberosity is discussed to play a role in the etiology of this injury. The aim of this study was to present a detailed, three‐dimensional anatomical analysis of the radioulnar space at the radial tuberosity. A total of 166 imprints of the radioulnar space in neutral rotation and pronation from 84 cadaveric specimens of both arms using silicone impression material were produced for this study. Imprints were cut in slices of 3 mm and digitally measured after picture acquisition using a high‐resolution digital camera. Distances were grouped into a proximal, central, and distal groups and used for correlation to morphometric data at the elbow (radial head diameter, ulna and radius length) as well as volume calculation. The mean radioulnar distance was 8.8 ± 4.0 mm in neutral rotation and 7.8 ± 3.9 mm in pronation. In pronation, the central zone was the smallest whereas in neutral rotation the proximal zone was the smallest. The volume of the radioulnar space did not reduce significantly during pronation. Little space is provided for the insertion of the distal biceps brachii tendon especially during pronation. This could play a role in the etiology of distal biceps brachii tendon ruptures and should be considered in the fixation after rupture of the tendon. Clin. Anat., 33:661–666, 2020. © 2019 Wiley Periodicals, Inc.

Distal biceps tendon ruptures occur with the almost extended elbow and supinated forearm – an online video analytic study

“…Seiler et al describe a mechanical impingement of the distal biceps tendon during pronation [ 18 ]. Rausch et al [ 20 ] also saw a smaller distance between the radius and the ulna at the radial tuberosity in pronation and suggested this as a risk factor for distal biceps tendon rupture [ 20 ]. The authors argue that mechanical impingement of the radioulnar space could be a significant risk factor for distal biceps tendon ruptures in general and in particular after distal biceps tendon repair [ 18 , 20 ].…”

“…Rausch et al [ 20 ] also saw a smaller distance between the radius and the ulna at the radial tuberosity in pronation and suggested this as a risk factor for distal biceps tendon rupture [ 20 ]. The authors argue that mechanical impingement of the radioulnar space could be a significant risk factor for distal biceps tendon ruptures in general and in particular after distal biceps tendon repair [ 18 , 20 ]. Heterotopic ossifications could also contribute to mechanical impingement and thus play a role in recurrent ruptures [ 20 ].…”

“…The authors argue that mechanical impingement of the radioulnar space could be a significant risk factor for distal biceps tendon ruptures in general and in particular after distal biceps tendon repair [ 18 , 20 ]. Heterotopic ossifications could also contribute to mechanical impingement and thus play a role in recurrent ruptures [ 20 ]. However, our data show an increased risk of tendon rupture in supination.…”

Acute complete and partial distal biceps tendon ruptures: what have we learned? A review

“…The effect of an anatomical reinsertion on the radioulnar space still has to be evaluated and considered when deciding where to reinsert the tendon. 19 , 57 …”

Distal Biceps Anatomy: Structural Morphometry and Dynamic Relationships

“…In a clinical scenario, postoperative DBT impingement in the RUS may be prevented by avoiding techniques that increase the thickness of the tendon and by using a reattachment site at the proximal aspect of the tuberosity [1]. Raush et al analyzed the radioulnar distance at the level of the radial tuberosity and found that the central zone was the smallest in pronation, and the proximal zone was the smallest in neutral rotation [12].…”