Ultrasound visualization of an underestimated structure: the bicipital aponeurosis

Abstract

PurposeWe established a detailed sonographic approach to the bicipital aponeurosis (BA), because different pathologies of this, sometimes underestimated, structure are associated with vascular, neural and muscular lesions; emphasizing its further implementation in routine clinical examinations.MethodsThe BA of 100 volunteers, in sitting position with the elbow lying on a suitable table, was investigated. Patients were aged between 18 and 28 with no history of distal biceps injury. Examination was performed using an 18–6 MHz linear transducer (LA435; system MyLab25 by Esaote, Genoa, Italy) utilizing the highest frequency, scanned in two planes (longitudinal and transverse view). In each proband, scanning was done with and without isometric contraction of the biceps brachii muscle.ResultsThe BA was characterized by two clearly distinguishable white lines enveloping a hypoechoic band. In all longitudinal images (plane 1), the lacertus fibrosus was clearly seen arising from the biceps muscle belly, the biceps tendon or the myotendinous junction, respectively. In transverse images (plane 2) the BA spanned the brachial artery and the median nerve in all subjects. In almost all probands (97/100), the BA was best distinguishable during isometric contraction of the biceps muscle.ConclusionWith the described sonographic approach, it should be feasible to detect alterations and unusual ruptures of the BA. Therefore, we suggest additional BA scanning during clinical examinations of several pathologies, not only for BA augmentation procedures in distal biceps tendon tears.

Ultrasonography, Microcomputed Tomography, and Macroscopic Preparation in an Anatomical Study of the Thoracic Limb of the Golden-Headed Lion Tamarin (Leontopithecus chrysomelas)

“…The graded compression technique was applied to move the transducer slowly over the muscles. The authors of other studies also used this method for the identification of individual muscles [43,44] as this technique visualises muscles better than others. In addition, US also enables the analysis of fascial structures [45].…”

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

“…Both techniques provide details about the extension of the rupture to a single head (short‐ or long‐head rupture) and extension to the lacertus fibrosus as well as evaluate the degree of tendon retraction (Figures and ) . Retraction of the belly muscle usually occurs when the lacertus fibrosus is torn or partial rupture of the long head has occurred, and it does not occur when only the short head is torn, probably because the latter is contiguous with the lacertus fibrosus . In addition, US enables one to differentiate between full and partial tears via posterior acoustic shadowing, which is present in 97% of full tears.…”

“…23 Retraction of the belly muscle usually occurs when the lacertus fibrosus is torn or partial rupture of the long head has occurred, and it does not occur when only the short head is torn, probably because the latter is contiguous with the lacertus fibrosus. 15,24 In addition, US enables one to differentiate between full and partial tears via posterior acoustic shadowing, which is present in 97% of full tears. However, an absence of shadowing does not effectively exclude the possibility of a partial tear.…”

“…The US appearance of the biceps brachii has been illustrated from the shoulder to the elbow by Brasseur . A detailed US approach to the lacertus fibrosus has been described by Konschake et al However, the technique for US examination of the DBBT at the elbow has been standardized by Tagliafico et al Anterior transverse and longitudinal views are realized on a fully extended elbow, following the schemas presented in Figures and . For optimal longitudinal views, the transducer pressure should be gently increased, and the US beam should be as parallel as possible to the tendon to avoid anisotropy.…”

Gender differences on effects of forearm rotation on compressive stiffness of flexor carpi ulnaris during submaximal handgrip contractions

“…For instance, in vitro has been reported that passive tension of the medial forearm musculature increases elbow stability when the forearm is supinated (Seiber et al, 2009). Certain researchers, including Konschake et al and Snoeck et al, have proposed that different structures, such as biceps brachii muscle (biceps) and antebrachial fascia, may be related to changes in the stiffness of the medial forearm muscle (Konschake et al, 2017; Snoeck, 2021; Snoeck et al, 2014). The biceps as supinator may increase the passive tension of the medial forearm musculature through the antebrachial fascia (Konschake et al, 2017, Snoeck, 2021, Snoeck et al, 2014).…”