Ultrasound demonstration of distal biceps tendon bifurcation: Normal and abnormal findings
Cattedra di Radiologia "R" - DICMI, Università di Genova, Genoa, Italy. European Radiology
(Impact Factor: 4.01).
09/2009; 20(1):202-8. DOI: 10.1007/s00330-009-1524-1
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.
Available from: Gregory Hoy
[Show abstract] [Hide abstract]
ABSTRACT: The purpose of this study was to describe the sonographic appearance of the common extensor origin in cadavers and asymptomatic volunteers, and to relate this appearance to the findings in patients with lateral epicondylitis.
Seventy-two elbows in 71 patients with lateral epicondylitis were examined on sonography. Most of the patients (60/71) gave a history of repetitive microtrauma. The injuries were evaluated with respect to location and severity. Focal areas of degeneration, discrete cleavage tears, and involvement of the lateral collateral ligament were identified. Calcification and bony changes were noted. The appearance of the normal common extensor tendon was described, and cadaveric specimens were dissected. Twenty-one patients subsequently underwent surgery.
The normal common extensor origin is composed of longitudinal fibrils bound closely with the extensor carpi radialis brevis constituting most of the deep fibers, with the extensor digitorum making up the superficial part. The lateral collateral ligament can be identified as a discrete and separate band. The most common appearance of lateral epicondylitis is a focal hypoechoic area in the deep part of the tendon (46/72). These focal areas were identified at surgery and corresponded histologically to collagen degeneration with fibroblastic proliferation. Often discrete cleavage planes traversing the tendon were manifest as partial (18/72) and complete (2/72) tears. The lateral collateral ligament was involved in eight of 72 elbows.
Sonography of the common extensor origin can be used to confirm lateral epicondylitis in patients with lateral elbow pain and provide information about the severity of the disease.
[Show abstract] [Hide abstract]
ABSTRACT: Acute and chronic elbow pain is common, particularly in athletes. Although plain radiographs, ultrasound, and computed tomography all have a role to play in the investigation of elbow pain, magnetic resonance imaging (MRI) has emerged as the imaging modality of choice for diagnosis of soft tissue disease and osteochondral injury around the elbow. The high spatial resolution, excellent soft-tissue contrast, and multiplanar imaging capabilities of MRI make it ideal for evaluating the complex joint anatomy of the elbow. This article reviews imaging of common disease conditions occurring around the elbow in athletes, with an emphasis on MRI.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.