Ultrasound classification of traumatic distal biceps brachii tendon injuries

Abstract

ObjectiveThe present work is aimed at analysing ultrasound findings in patients with distal biceps brachii tendon (DBBT) injuries to assess the sensitivity of ultrasound in detecting the different forms of injury, and to compare ultrasound results with magnetic resonance imaging (MRI) and surgical results.Materials and methodsA total of 120 patients with traumatic DBBT injuries examined between 2011 and 2015 were analysed. We compared ultrasound results with MRI results when surgery was not indicated and with MRI and surgical results when surgery was indicated.ResultsFor major DBBT injuries (complete tears and high-grade partial tears), the concordance study between exploration methods and surgical results found that ultrasound presented a slight statistically significant advantage over MRI (ultrasound: κ = 0.95—very good—95% CI 0.88 to 1.01, MRI: κ = 0.63—good—95% CI 0.42 to 0.84, kappa difference p < 0.01). Minor injuries, in which most tendon fibres remain intact (tendinopathies, elongations and low-grade partial tears), are the most difficult to interpret, as ultrasound and MRI reports disagreed in 12 out of 39 cases and no surgical confirmation could be obtained.ConclusionsBased on present results and previous MRI classifications, we establish a traumatic DBBT injury ultrasound classification. The sensitivity and ultrasound–surgery correlation results in the diagnosis of major DBBT injuries obtained in the present study support the recommendation that ultrasound can be used as a first-line imaging modality to evaluate DBBT injuries.

Ultrasound of the elbow with emphasis on the sonoanatomy of the distal biceps tendon and its importance for the surgical treatment of tendon lesions

“…A partial or complete rupture of the dBT can be visualized by high-resolution musculoskeletal ultrasound or MR. In cases of partial tears (less than 50% affected) ( 5 ) , patients are usually treated conservatively ( 6 , 7 ) . However, there is a high failure rate (up to 56%) in patients with partial ruptures involving more than 50% of the dBT and in patients with a high physical load and repetitive activities ( 8 ) .…”

“…The degree of tendon retraction is not necessarily an indicator of the condition of the lacertus fibrosus, so it must be assessed separately (4) . The detailed assessment of the biceps tendon footprint supports, due to high anatomical variation of the position and shape of the tuberosity and insertion of the long biceps tendon, among other things, surgical reconstruction (including bone tunnels, suture anchors) (5)(6)(7) .…”

Distal Biceps Brachii Tendon Insertion

“…The distal biceps brachii tendon lands on the radial tuberosity with two slightly separated components: the one that originates predominantly from the long head of the muscle inserts more proximally; whereas the one that originates predominantly from the short head inserts more distally 1,2 . They are enclosed by the same paratenon 3,4 .…”

Ultrasonography of Complications in Surgical Repair of the Distal Biceps Brachii Tendon

“…Distal biceps brachii tendon ruptures typically occur in the dominant arm of men between 30 and 60 years who apply an intense extension force to the anterior aspect of the forearm with the elbow in an active flexed position. 26 Various conditions can predispose one to DBBT rupture, such as tendon degeneration and hypovascularity, mechanical conflicts with bony spurs at the radial tuberosity, and use of tobacco or anabolic steroids. 5 The most common pathologic mechanism leading to DBBT rupture is simultaneous powerful contraction of the muscle and passive extension of the elbow.…”