ARRS 2022 Abstracts

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E1407. Biceps Brachii Tendon: Spectrum of Pathologies on Ultrasound With Clinical and MR Correlation
Authors
  1. Akriti Khanna; Mayo Clinic
  2. Christin Tiegs-Heiden; Mayo Clinic
  3. John Skinner; Mayo Clinic
  4. Gavin McKenzie; Mayo Clinic
  5. Michael Moynagh; Mayo Clinic
  6. Katrina Glazebrook; Mayo Clinic
Background
The biceps brachii tendon is composed of the short head, which originates from the coracoid process of the scapula, and the long head, which originates from the supraglenoid tubercle. Their distal muscle bellies combine, course anteriorly across the elbow, and jointly insert on the radial tuberosity (Hutchinson and Eames). This tendon can be a common source of pathology and cause symptoms in the shoulder and the elbow.

Educational Goals / Teaching Points
There is a wide range of biceps brachii tendon abnormalities, the majority of which can be accurately diagnosed by ultrasound. The spectrum of findings includes partial or complete tears of the proximal and distal biceps tendons, tendinosis, tenosynovitis, subluxation or dislocation of the tendon, bicipitoradial bursitis, and complications after surgical repair of the biceps tendon. Ultrasound is a helpful modality in the evaluation of biceps tendon pathology, especially when the exact location of injury is unclear.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Both the proximal and distal biceps tendon can be adequately imaged by ultrasound and the patient can be accurately diagnosed with acute or chronic abnormalities by the end of the study. In addition, ultrasound is a low-cost modality with the added benefit of being a dynamic study that can utilize physical maneuvers in real time for problem solving. These biceps tendon pathologies can also be evaluated by MRI; however, with increased cost, more variability in study quality due to artifacts, limited evaluation of the entire biceps tendon, and lack of dynamic information.

Conclusion
Many biceps tendon abnormalities such as tendon ruptures and tears require surgical management, whereas other entities such as tendinosis and tenosynovitis are managed conservatively. Acute pathologies of the biceps tendon, such as an acute rupture, benefit from a short, targeted study such as ultrasound that can lead to the diagnosis and pre-surgical planning quickly and accurately. The purpose of this presentation is to highlight the spectrum of biceps tendon pathologies with an emphasis on ultrasound. Image-rich examples are provided to increase comfort and confidence among the audience in diagnosing biceps tendon pathology. Additionally, relevant MR correlates, clinical history, presentation will be provided for completeness.