Semin Musculoskelet Radiol 2021; 25(04): 566-573
DOI: 10.1055/s-0041-1735466
Review Article

Biceps, Brachialis, and Triceps

Thibault Willaume
1   MSK Radiology, University Hospital of Strasbourg, Strasbourg, France
,
1   MSK Radiology, University Hospital of Strasbourg, Strasbourg, France
› Author Affiliations

Abstract

Tendon injuries at the elbow affect mostly the distal biceps and can progressively degenerate over time or rupture in an acute event. The degree of retraction may depend on the integrity of the lacertus fibrosus, a fibrous expansion that merges with the forearm flexor fascia. Biceps disorders are frequently associated with fluid or synovitis of the adjacent bicipital bursa; primary bursal disorders (primary inflammatory synovitis) can also be observed. Distal triceps is less frequently injured than the distal biceps, and tears usually manifest as distal ruptures with avulsion of a small flake of bone from the tip of the olecranon. Brachialis injuries are uncommon and the consequence of sudden muscle stretching during forced elbow hyperextension, as in posterior elbow luxation.

Supplementary Material



Publication History

Article published online:
27 October 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Chew ML, Giuffrè BM. Disorders of the distal biceps brachii tendon. Radiographics 2005; 25 (05) 1227-1237
  • 2 Koch S, Tillmann B. The distal tendon of the biceps brachii. Structure and clinical correlations. Ann Anat 1995; 177 (05) 467-474
  • 3 Forthman CL, Zimmerman RM, Sullivan MJ, Gabel GT. Cross-sectional anatomy of the bicipital tuberosity and biceps brachii tendon insertion: relevance to anatomic tendon repair. J Shoulder Elbow Surg 2008; 17 (03) 522-526
  • 4 Athwal GS, Steinmann SP, Rispoli DM. The distal biceps tendon: footprint and relevant clinical anatomy. J Hand Surg Am 2007; 32 (08) 1225-1229
  • 5 Sakurai G, Ozaki J, Tomita Y, Nishimoto K, Tamai S. Electromyographic analysis of shoulder joint function of the biceps brachii muscle during isometric contraction. Clin Orthop Relat Res 1998; (354) 123-131
  • 6 Clark D, Astle L, Monsell F, Livingstone J. The bicipital aponeurosis may be involved in the anatomical etiology of arterial compromise after swelling in supracondylar fracture. J Orthop Trauma 2009; 23 (10) 731-733
  • 7 Joshi SD, Yogesh AS, Mittal PS, Joshi SS. Morphology of the bicipital aponeurosis: a cadaveric study. Folia Morphol (Warsz) 2014; 73 (01) 79-83
  • 8 Draghi F, Gregoli B, Sileo C. Sonography of the bicipitoradial bursa: a short pictorial essay. J Ultrasound 2012; 15 (01) 39-41
  • 9 Bhatia DN. Endoscopic anatomy of distal biceps tendon insertion and bicipitoradial bursa: a cadaveric study. J Shoulder Elbow Surg 2021; January 21 (Epub ahead of print)
  • 10 Safran MR, Graham SM. Distal biceps tendon ruptures: incidence, demographics, and the effect of smoking. Clin Orthop Relat Res 2002; (404) 275-283
  • 11 Seiler III JG, Parker LM, Chamberland PD, Sherbourne GM, Carpenter WA. The distal biceps tendon. Two potential mechanisms involved in its rupture: arterial supply and mechanical impingement. J Shoulder Elbow Surg 1995; 4 (03) 149-156
  • 12 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 (05) 767-770
  • 13 Bourne MH, Morrey BF. Partial rupture of the distal biceps tendon. Clin Orthop Relat Res 1991; (271) 143-148
  • 14 de la Fuente J, Blasi M, Martínez S. et al. Ultrasound classification of traumatic distal biceps brachii tendon injuries. Skeletal Radiol 2018; 47 (04) 519-532
  • 15 Anakwenze OA, Baldwin K, Abboud JA. Distal biceps tendon repair: an analysis of timing of surgery on outcomes. J Athl Train 2013; 48 (01) 9-11
  • 16 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 (01) 77-83
  • 17 Giuffrè BM, Moss MJ. Optimal positioning for MRI of the distal biceps brachii tendon: flexed abducted supinated view. AJR Am J Roentgenol 2004; 182 (04) 944-946
  • 18 Lobo LdaG, Fessell DP, Miller BS. et al. The role of sonography in differentiating full versus partial distal biceps tendon tears: correlation with surgical findings. AJR Am J Roentgenol 2013; 200 (01) 158-162
  • 19 Nicolay RW, Lawton CD, Selley RS. et al. Partial rupture of the distal biceps brachii tendon: a magnetic resonance imaging analysis. J Shoulder Elbow Surg 2020; 29 (09) 1859-1868
  • 20 Lee JH, Kim KC, Lee JH, Ahn KB, Rhyou IH. A case series of symptomatic distal biceps tendinopathy. Clin Shoulder Elbow 2018; 21 (04) 213-219
  • 21 Hobbs MC, Koch J, Bamberger HB. Distal biceps tendinosis: evidence-based review. J Hand Surg Am 2009; 34 (06) 1124-1126
  • 22 Eames MH, Bain GI, Fogg QA, van Riet RP. Distal biceps tendon anatomy: a cadaveric study. J Bone Joint Surg Am 2007; 89 (05) 1044-1049
  • 23 Faict S, Van de Meulebroucke B, Van Royen K, Bleys D, Rezaie W, Middernacht B. Distal biceps section and reinsertion for chronic distal biceps tendinopathy. Eur J Orthop Surg Traumatol 2019; 29 (07) 1405-1409
  • 24 Blasi M, De la Fuente J, Pérez-Bellmunt A. et al. High-resolution ultrasound in the assessment of the distal biceps brachii tendinous complex. Skeletal Radiol 2019; 48 (03) 395-404
  • 25 Leonello DT, Galley IJ, Bain GI, Carter CD. Brachialis muscle anatomy. A study in cadavers. J Bone Joint Surg Am 2007; 89 (06) 1293-1297
  • 26 Kamineni S, Bachoura A, Behrens W, Kamineni E, Deane A. Distal insertional footprint of the brachialis muscle: 3D morphometric study. Anat Res Int 2015; 2015: 786508
  • 27 Klonz A, Loitz D, Wöhler P, Reilmann H. Rupture of the distal biceps brachii tendon: isokinetic power analysis and complications after anatomic reinsertion compared with fixation to the brachialis muscle. J Shoulder Elbow Surg 2003; 12 (06) 607-611
  • 28 Sharma P, Mehta N, Narayan A. Isolated traumatic brachialis muscle tear: a case report and review of literature. Bull Emerg Trauma 2017; 5 (04) 307-310
  • 29 Murugappan KS, Mohammed K. Acute traumatic brachialis rupture in a young rugby player: a case report. J Shoulder Elbow Surg 2012; 21 (06) e12-e14
  • 30 Krych AJ, Kohen RB, Rodeo SA, Barnes RP, Warren RF, Hotchkiss RN. Acute brachialis muscle rupture caused by closed elbow dislocation in a professional American football player. J Shoulder Elbow Surg 2012; 21 (07) e1-e5
  • 31 Rudy BS, Armstrong AD. Atraumatic snapping brachialis in a 37-year-old woman. JAAPA 2007; 20 (01) 48 , 50–51
  • 32 Keener JD, Chafik D, Kim HM, Galatz LM, Yamaguchi K. Insertional anatomy of the triceps brachii tendon. J Shoulder Elbow Surg 2010; 19 (03) 399-405
  • 33 Negrão JR, Mogami R, Ramirez Ruiz FA. et al. Distal insertional anatomy of the triceps brachii muscle: MRI assessment in cadaveric specimens employing histologic correlation and Play-doh® models of the anatomic findings. Skeletal Radiol 2020; 49 (07) 1057-1067
  • 34 Belentani C, Pastore D, Wangwinyuvirat M. et al. Triceps brachii tendon: anatomic-MR imaging study in cadavers with histologic correlation. Skeletal Radiol 2009; 38 (02) 171-175
  • 35 Keener JD, Sethi PM. Distal triceps tendon injuries. Hand Clin 2015; 31 (04) 641-650
  • 36 Walker CM, Noonan TJ. Distal triceps tendon injuries. Clin Sports Med 2020; 39 (03) 673-685
  • 37 Lee JH, Ahn KB, Kwon KR. et al. Differences in rupture patterns and associated lesions related to traumatic distal triceps tendon rupture between outstretched hand and direct injuries. Clin Orthop Relat Res 2020; 479 (04) 781-789
  • 38 Waterman BR, Dean RS, Veera S. et al. Surgical repair of distal triceps tendon injuries: short-term to midterm clinical outcomes and risk factors for perioperative complications. Orthop J Sports Med 2019; 7 (04) 2325967119839998
  • 39 Farrar III EL, Lippert III FG. Avulsion of the triceps tendon. Clin Orthop Relat Res 1981; (161) 242-246
  • 40 Pina A, Garcia I, Sabater M. Traumatic avulsion of the triceps brachii. J Orthop Trauma 2002; 16 (04) 273-276
  • 41 Koplas MC, Schneider E, Sundaram M. Prevalence of triceps tendon tears on MRI of the elbow and clinical correlation. Skeletal Radiol 2011; 40 (05) 587-594
  • 42 Kholinne E, Al-Ramadhan H, Bahkley AM, Alalwan MQ, Jeon IH. MRI overestimates the full-thickness tear of distal triceps tendon rupture. J Orthop Surg (Hong Kong) 2018; 26 (02) 2309499018778364
  • 43 Bos CF, Nelissen RG, Bloem JL. Incomplete rupture of the tendon of triceps brachii. A case report. Int Orthop 1994; 18 (05) 273-275
  • 44 Tagliafico A, Gandolfo N, Michaud J, Perez MM, Palmieri F, Martinoli C. Ultrasound demonstration of distal triceps tendon tears. Eur J Radiol 2012; 81 (06) 1207-1210
  • 45 Sibley PA, Harman TW, Bamberger HB. Triceps tendinopathy. J Hand Surg Am 2015; 40 (07) 1446-1448
  • 46 Rineer CA, Ruch DS. Elbow tendinopathy and tendon ruptures: epicondylitis, biceps and triceps ruptures. J Hand Surg Am 2009; 34 (03) 566-576
  • 47 Groves C, Chandramohan M, Chew NS, Aslam T, Helliwell PS. Clinical examination, ultrasound and MRI imaging of the painful elbow in psoriatic arthritis and rheumatoid arthritis: which is better, ultrasound or MR, for Imaging enthesitis?. Rheumatol Ther 2017; 4 (01) 71-84