A thorough insight on distal biceps tendon: anatomic variants that simulate lesions, peritendinous structures, tears and postoperative aspect

This poster is published under an open license. Please read the disclaimer for further details.

Congress:

ECR 2017

Poster Number:

C-1510

Type:

Educational Exhibit

Keywords:

Trauma, Athletic injuries, Surgery, Normal variants, Education, MR, Musculoskeletal soft tissue, Musculoskeletal joint

Authors:

R. F. M. D. Amaral¹, F. Machado do Amaral¹, J. C. Garcia Junior¹, D. M. S. Lucena², A. Rosenfeld¹, A. Y. Aihara¹, H. Guidorizzi¹, C. Longo¹; ¹Sao Paulo/BR, ²Recife/BR

DOI:

10.1594/ecr2017/C-1510

DOI-Link:

https://dx.doi.org/10.1594/ecr2017/C-1510

Fig. 2: FABS (flexed abducted supinated) position demonstrate the distal biceps tendon...

Fig. 1: MRI images in a 33-year-old male patient. Coronal (A), sagittal (B) and axial...

Fig. 3: MRI preoperative images in a 42-year-old male patient. Axial (A) and coronal...

Fig. 4: MRI postoperative images in the same patient on previously figure. Sagittal...

Fig. 5: MRI images in a 55-year-old male patient. Axial (A) and sagittal (B)...

Fig. 6: MRI images demonstrating a normal lacertus fibrosus. Axial (A) and sagittal (B)...

Findings and procedure details

The distal biceps tendon is usually studied in distal arm and elbow protocols on MRI. Axial images that provide short-axis images of the tendon are very important.

The normal tendon is low signal on all sequences and appear as a single tendon in the majority of cases, but can also appear as a partially bifurcated or two separate tendons as well.

FABS position (flexed elbow, abducted shoulder, forearm supinated) sequences may be useful to improve imaging of the distal biceps insertion. This position makes a longitudinal view of the tendon in one section, including the insertion on the radial tuberosity, and can make it easier to differentiate partial from complete tears.

Post-operative

The imaging aspect of the normal postoperative distal biceps tendon includes thickening of the tendon, and can be associated with some foci of heterotopic ossifications. Soft tissue edema can persist for several weeks.

It’s important to distinguish the normal postoperative distal biceps tendon from rerupture, that will appear with more edema than expected and tendon discontinuity associated with consistent clinic and physical exam.