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



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.


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.


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.


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



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).


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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

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