Ultrasound demonstration of distal biceps tendon bifurcation: normal and abnormal findings

Abstract

We demonstrate the US appearance of the distal biceps tendon bifurcation in normal cadavers and volunteers and in those affected by various disease processes. Three cadaveric specimens, 30 normal volunteers, and 75 patients were evaluated by means of US. Correlative MR imaging was obtained in normal volunteers and patients. In all cases US demonstrated the distal biceps tendon shaped by two separate tendons belonging to the short and long head of the biceps brachii muscle. Four patients had a complete rupture of the distal insertion of the biceps with retraction of the muscle belly. Four patients had partial tear of the distal biceps tendon with different US appearance. In two patients the partial tear involved the short head of the biceps brachii tendon, while in the other two patients, the long head was involved. Correlative MR imaging is also presented both in normal volunteers and patients. US changed the therapeutic management in the patients with partial tears involving the LH of the biceps. This is the first report in which ultrasound considers the distal biceps tendon bifurcation in detail. Isolated tears of one of these components can be identified by US. Knowledge of the distal biceps tendon bifurcation ultrasonographic anatomy and pathology has important diagnostic and therapeutic implications.

Chronic Partial Rupture of Distal Biceps Tendon in an Adolescent―A Case Report

“…In light of these predisposing factors for a distal biceps tendon injury, it is exceedingly rare to see distal biceps tendon injury in the young population. Partial tears of distal biceps tendon may be traumatic or attritional and usually involve only one of the components of biceps tendon (short head or long head) [4]- [6]. Our patient did not recall any history of trauma.…”

“…Partial tears involving the long head of biceps tendon usually presents with a typical Popeye sign which is a soft tissue lump over the anterior aspect of the middle third of arm, suggesting retraction of belly of biceps which was not seen in our patient [4]. Sometimes the symptoms of partial biceps tendon tear may even mimic or co-exist with conditions like bicipital tendinosis, leading to missed or delay in the diagnosis of chronic distal biceps tendon tear [17].…”

“…They occur most frequently in the older adult population aged 40 -60 years and are more common in men [5] [6] [8]- [12]. Complete tears are relatively common in men and usually traumatic in origin, whereas partial tears of distal biceps tendon are more common in women and usually have an insidious onset [4] [10] [11]. The result for gender disparity in the frequency of distal biceps tendon tear remains unclear [10].…”

Musculoskeletal imaging: current and future trends

“…Recent anatomical studies have demonstrated that the distal biceps brachii tendon consists of two separate tendons rather than a single tendon as previously thought. Tagliafico and co-workers assessed the sonographic appearance of the distal biceps tendon bifurcation in healthy volunteers and in patients with tear of the distal biceps tendon and correlated the sonographic findings with MRI [5]. In their study, ultrasound demonstrated the two separate tendons of the distal biceps tendon in all volunteers and patients and was able to differentiate between complete tendon rupture, partial tear of the short and long head of the biceps tendon.…”

The biceps tendons: From the top and from the bottom

“…An Italian-Canadian study [1] has shown that the distal insertion of the tendon on the radial tuberosity is bifurcated; the presence of a bursa allows it to slide smoothly around the tuberosity during pronation-supination of the forearm. In addition to this bifid tendon, there is a third distal structure known as the Lacertus fibrosus, or bicipital aponeurosis, which detaches from the medial aspect of the tendon, crosses over the median artery and median nerve, and inserts onto the superficial aponeurosis of the flexor muscles.…”