ARRS 2022 Abstracts


E1972. Ultrasound and MRI of the Distal Biceps Brachii: Anatomy, Pathology, Pitfalls, and Ultrasound-guided Tendon Treatments
  1. Daniel Morgan; University of Cincinnati
  2. Jon Jacobson; University of Cincinnati
  3. Casey Reed; University of Cincinnati
  4. Eric England; University of Cincinnati
  5. Artemis Petrides; University of Cincinnati
  6. Jeff Youngquist; University of Cincinnati
  7. Susan Braley; University of Cincinnati
Pathology of the distal biceps brachii tendon at the elbow can be challenging to interpret at imaging. Both ultrasound and MRI have shown to be effective, but there are several pitfalls that exist related to complex anatomy of the distal biceps, errors in imaging technique, and misinterpretation of pathology. For example, accurate diagnosis of partial biceps tears is dependent on familiarity with the distal tendon anatomy. In addition, various ultrasound-guided percutaneous tendon treatments are now offered where familiarity with such scanning techniques is important for treatment success. The purpose of this exhibit is to provide a comprehensive review of the distal biceps brachii regarding anatomy, pathology, and guided procedures using ultrasound and MRI.

Educational Goals / Teaching Points
The educational goals are to (1) review essential anatomy of the distal biceps brachii; (2) review the various ultrasound scanning techniques; (3) review pathology of the biceps tendon including tendinosis, partial and complete tendon tears, and bicipitoradial bursitis as shown with ultrasound and MRI; and (4) review the rationale and interventional techniques for tendon treatments such as fenestration, whole blood injection, and platelet-rich plasma (PRP) injection.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The individual short and long head tendons of the distal biceps brachii are visible at imaging and rotate at their terminal bifurcation inserting on the radial tuberosity. Knowledge of the terminal bifurcation anatomy predicts the imaging findings of partial tendon tears involving the short or long head as shown on ultrasound and MRI. Of the several ultrasound scanning techniques for the biceps brachii, the anterior and medial approaches are essential to identify pathology. Dynamic sonographic evaluation with pronation and supination differentiates partial from complete non-retracted biceps tendon tears. A dorsal ultrasound scanning approach is used to treat the distal biceps tendon with fenestration, whole blood injection, or PRP, each being effective to treat biceps tendinosis and non-retracted tears.

Knowledge of anatomy, understanding ultrasound scanning techniques, and familiarity with distal biceps pathology will allow accurate diagnosis impacting patient care. Percutaneous ultrasound-guided treatments of biceps pathology can be considered as a treatment.