Advertisement

Skeletal Radiology

, Volume 48, Issue 3, pp 395–404 | Cite as

High-resolution ultrasound in the assessment of the distal biceps brachii tendinous complex

  • M. Blasi
  • J. De la Fuente
  • A. Pérez-Bellmunt
  • O. Zabalza
  • S. Martínez
  • O. Casasayas
  • M. Miguel-PérezEmail author
Scientific Article
  • 178 Downloads

Abstract

Objective

To establish a high-resolution US technique that enables a systematic morphometric examination of the three components that form the distal biceps brachii tendinous complex; the internal bicipital aponeurosis, the distal biceps brachii tendon and the external bicipital aponeurosis (also known as lacertus fibrosus).

Materials and methods

Fifty cryopreserved cadaver body donor elbows were dissected to obtain morphometric reference values and to establish reliable landmarks for the US examination. Then, a systematic US technique was designed and validated by a one-to-one US/dissection analysis of 11 cryopreserved cadaver body donor elbows. Finally, the systematic US technique was carried out in 44 healthy volunteers and morphometric parameters were compared to those obtained in the first part of the study.

Results

Mean dissection reference values: internal bicipital aponeurosis width 39.61 mm (10.02 SD) and thickness 0.75 mm (0.24 SD), distal biceps brachii tendon width 8.38 mm (1.87 SD) and thickness 2.73 mm (0.69 SD), external bicipital aponeurosis width 11.17 mm (5.84 SD) and thickness 0.85 mm (0.28 SD). One-to-one US/dissection correlation was overall good (intraclass correlation coefficient 0.876, p < 0.0001). When comparing volunteer US/dissection measurements, significant differences were encountered in all measures except for internal bicipital aponeurosis width. However, the overall magnitude of such significant differences was < 0.7 mm.

Conclusions

Using the systematics hereby proposed, high-resolution US is reliable for the morphometric assessment of the distal biceps brachii tendinous complex. The external bicipital aponeurosis is morphometrically the most variable structure.

Keywords

Distal biceps brachii tendon Lacertus fibrosus External bicipital aponeurosis Internal bicipital aponeurosis Ultrasound imaging 

Notes

Acknowledgements

The authors are thankful to body donors and volunteers that enable the study of basic and clinical anatomy. We also thank the dissection room staff: Josep Lluís Ramon, Gemma Ramon, Nieves Cayuela, Cristobal Martín and Alicia Rodrigo, for their help and assistance. Finally, we thank the Bruguera Tennis Academy for allowing us to examine elite tennis players and Mathias Simon for his assistance during data gathering.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures involving human participants were in accordance with the ethical standards of the Clinical Research Ethics Committee (CEIC).

References

  1. 1.
    Giuffre BM, Lisle DA. Tear of the distal biceps brachii tendon: a new method of ultrasound evaluation. Australas Radiol. 2005;49:404–6.CrossRefGoogle Scholar
  2. 2.
    Festa A, Mulieri PJ, Newman JS, Spitz DJ, Leslie BM. Effectiveness of magnetic resonance imaging in detecting partial and complete distal biceps tendon rupture. J Hand Surg [Am]. 2010;35:77–83.  https://doi.org/10.1016/j.jhsa.2009.08.016.CrossRefGoogle Scholar
  3. 3.
    Smith J, Finnoff JT, O’Driscoll SW, Lai JK. Sonographic evaluation of the distal biceps tendon using a medial approach: the pronator window. J Ultrasound Med. 2010;29:861–5.CrossRefGoogle Scholar
  4. 4.
    Tagliafico A, Michaud J, Capaccio E, Derchi LE, Martinoli C. Ultrasound demonstration of distal biceps tendon bifurcation: normal and abnormal findings. Eur Radiol. 2010;20:202–8.  https://doi.org/10.1007/s00330-009-1524-1.CrossRefPubMedGoogle Scholar
  5. 5.
    Brasseur JL. The biceps tendons: from the top and from the bottom. J Ultrasound. 2012;15:29–38.  https://doi.org/10.1016/j.jus.2011.11.002.CrossRefPubMedGoogle Scholar
  6. 6.
    Brigido MK, De Maeseneer M, Morag Y. Distal biceps brachii. Semin Musculoskelet Radiol. 2013;17:20–7.  https://doi.org/10.1055/s-0033-1333910. ReviewCrossRefPubMedGoogle Scholar
  7. 7.
    Champlin J, Porrino J, Dahiya N, Taljanovic M. A visualization of the distal biceps tendon. PM R. 2017;9:210–5.  https://doi.org/10.1016/j.pmrj.2016.10.005.CrossRefPubMedGoogle Scholar
  8. 8.
    de la Fuente J, Blasi M, Martínez S, et al. Ultrasound classification of traumatic distal biceps brachii tendon injuries. Skelet Radiol. 2018;47(4):519–32.  https://doi.org/10.1007/s00256-017-2816-1.CrossRefGoogle Scholar
  9. 9.
    Dirim B, Brouha SS, Pretterklieber ML, Wolff KS, Frank A, Pathria MN, et al. Terminal bifurcation of the biceps brachii muscle and tendon: anatomic considerations and clinical implications. AJR Am J Roentgenol. 2008;191:W248–55.  https://doi.org/10.2214/AJR.08.1048.CrossRefPubMedGoogle Scholar
  10. 10.
    Blasi M, de la Fuente J, Martinoli C, et al. Multidisciplinary approach to the persistent double distal tendon of the biceps brachii. Surg Radiol Anat. 2014;36:17–24.  https://doi.org/10.1007/s00276-013-1136-y.CrossRefPubMedGoogle Scholar
  11. 11.
    Eames MH, Bain GI, Fogg QA, van Riet RP. Distal biceps tendon anatomy: a cadaveric study. J Bone Joint Surg Am. 2007;89:1044–9.PubMedGoogle Scholar
  12. 12.
    Testut L, Latarjet A. Tratado de Anatomía Humana. 8th ed. Barcelona: Salvat Editores, S.A.; 1944.Google Scholar
  13. 13.
    Pappas GP, Asakawa DS, Delp SL, Zajac FE, Drace JE. Nonuniform shortening in the biceps brachii during elbow flexion. J Appl Physiol (1985). 2002;92:2381–9.CrossRefGoogle Scholar
  14. 14.
    Stecco A, Macchi V, Stecco C, et al. Anatomical study of myofascial continuity in the anterior region of the upper limb. J Bodyw Mov Ther. 2009;13:53–62.  https://doi.org/10.1016/j.jbmt.2007.04.009.CrossRefPubMedGoogle Scholar
  15. 15.
    Snoeck O, Lefèvre P, Sprio E, et al. The lacertus fibrosus of the biceps brachii muscle: an anatomical study. Surg Radiol Anat. 2014;36:713–9.  https://doi.org/10.1007/s00276-013-1254-6.CrossRefPubMedGoogle Scholar
  16. 16.
    Nayak SB, Swamy RS, Shetty P, Maloor PA, Dsouza MR. Bifurcated bicipital aponeurosis giving origin to flexor and extensor muscles of the forearm—a case report. J Clin Diagn Res. 2016;10:AD01–2.  https://doi.org/10.7860/JCDR/2016/17714.7215.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Joshi SD, Yogesh AS, Mittal PS, Joshi SS. Morphology of the bicipital aponeurosis: a cadaveric study. Folia Morphol (Warsz). 2014;73:79–83.  https://doi.org/10.5603/FM.2014.0011.CrossRefGoogle Scholar
  18. 18.
    De Maeseneer M, Brigido MK, Antic M, et al. Ultrasound of the elbow with emphasis on detailed assessment of ligaments, tendons, and nerves. Eur J Radiol. 2015;84(4):671–81.  https://doi.org/10.1016/j.ejrad.2014.12.007. ReviewCrossRefPubMedGoogle Scholar
  19. 19.
    Konschake M, Stofferin H, Moriggl B. Ultrasound visualization of an underestimated structure: the bicipital aponeurosis. Surg Radiol Anat. 2017;39:1317–22.  https://doi.org/10.1007/s00276-017-1885-0.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Le Huec JC, Moinard M, Liquois F, Zipoli B, Chauveaux D, Le Rebeller A. Distal rupture of the tendon of biceps brachii. Evaluation by MRI and the results of repair. J Bone Joint Surg (Br). 1996;78:767–70. Erratum in: J Bone Joint Surg Br 1997 Jul;79(4):693CrossRefGoogle Scholar
  21. 21.
    Landa J, Bhandari S, Strauss EJ, Walker PS, Meislin RJ. The effect of repair of the lacertus fibrosus on distal biceps tendon repairs: a biomechanical, functional, and anatomic study. Am J Sports Med. 2009;37:120–3.  https://doi.org/10.1177/0363546508324694.CrossRefPubMedGoogle Scholar
  22. 22.
    Murthi AM, Ramirez MA, Parks BG, Carpenter SR. Lacertus fibrosus versus Achilles allograft reconstruction for distal biceps tears: a biomechanical study. Am J Sports Med. 2017;45:3340–4.  https://doi.org/10.1177/0363546517727511.CrossRefPubMedGoogle Scholar
  23. 23.
    Nelson KR, Goodheart R, Salotto A, Tibbs P. Median nerve entrapment beneath the bicipital aponeurosis: investigation with intraoperative short segment stimulation. Muscle Nerve. 1994;17:1221–3.CrossRefGoogle Scholar
  24. 24.
    Cevirme D, Aksoy E, Adademir T, Sunar H. A perplexing presentation of entrapment of the brachial artery. Case Rep Vasc Med. 2015;2015:236193.  https://doi.org/10.1155/2015/236193.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Caetano EB, Vieira LA, Almeida TA, Gonzales LAM, Bona JE, Simonatto TM. Bicipital aponeurosis. Anatomical study and clinical implications. Rev Bras Ortop. 2017;53:75–81.CrossRefGoogle Scholar
  26. 26.
    Kayser R, Mahlfeld K, Scheller W, Müller J, Schmidt W, Heyde CE. Sonographic imaging of the distal biceps tendon—an experimental and clinical study. Ultraschall Med. 2005;26:17–23.CrossRefGoogle Scholar
  27. 27.
    Safran MR, Graham SM. Distal biceps tendon ruptures: incidence, demographics, and the effect of smoking. Clin Orthop Relat Res. 2002 Nov;(404):275–283.Google Scholar
  28. 28.
    Cucca YY, McLay SV, Okamoto T, Ecker J, McMenamin PG. The biceps brachii muscle and its distal insertion: observations of surgical and evolutionary relevance. Surg Radiol Anat. 2010;3:371–5.  https://doi.org/10.1007/s00276-009-0575-y.CrossRefGoogle Scholar
  29. 29.
    Kulshreshtha R, Singh R, Sinha J, Hall S. Anatomy of the distal biceps brachii tendon and its clinical relevance. Clin Orthop Relat Res. 2007;456:117–20.CrossRefGoogle Scholar

Copyright information

© ISS 2018

Authors and Affiliations

  • M. Blasi
    • 1
    • 2
  • J. De la Fuente
    • 3
  • A. Pérez-Bellmunt
    • 2
  • O. Zabalza
    • 4
  • S. Martínez
    • 5
  • O. Casasayas
    • 2
  • M. Miguel-Pérez
    • 6
    • 7
    Email author
  1. 1.Department of Fundamental Care and Medical-Surgical Nursing, Faculty of Medicine and Health Sciences (Bellvitge Campus)University of BarcelonaBarcelonaSpain
  2. 2.Àrea d’Estructura i Funció del Cos Humà, Facultat de Medicina i Ciències de la SalutUniversitat Internacional de CatalunyaBarcelonaSpain
  3. 3.Orthopedic DepartmentClínica Pakea-MutualiaSan SebastiánSpain
  4. 4.Unidad de análisis y apoyo a la investigación de MutualiaHospital Alta Resolución-MutualiaVitoriaSpain
  5. 5.Radiology DepartmentHospital Universitario de BurgosBurgosSpain
  6. 6.Human and Embryology Anatomy Unit, Experimental Pathology and Therapeutic Department, Faculty of Medicine and Health Sciences (Bellvitge Campus)University of BarcelonaBarcelonaSpain
  7. 7.Hospitalet de LlobregatBarcelonaSpain

Personalised recommendations