Download PDF
Semin Musculoskelet Radiol 2024; 28(06): 725-739
DOI: 10.1055/s-0044-1790526
Review Article

Pre- and Postoperative Ultrasound Assessment of Biceps Brachial Tendon Tears

Jean-Baptiste Pialat 
1   Department of Radiology, Hôpital Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
2   Faculté de Médecine Lyon-Sud, Université Claude Bernard Lyon 1, Pierre-Bénite, France
,
Antoine Moraux
3   Imagerie Médicale Jacquemars Giélée, Lille, France
4   CLIMAL Medical Imaging Center, Lille, France
,
Yacine Carlier
5   Department of Orthopaedic Surgery and Traumatology, Centre de l'Arthrose de Mérignac, Clinique du Sport, Mérignac, France
,
Lionel Pesquer
6   Department of Musculoskeletal Imaging, Enosis, Clinique du Sport, Mérignac, France
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Rupture of the distal biceps brachii tendon is a rare but debilitating injury, resulting in significant loss of strength. Diagnosis of complete rupture is based on clinical history and physical tests, with surgical repair often recommended due to functional discomfort. Ultrasound (US) is a powerful tool for diagnosing and classifying ruptures, particularly partial ruptures, which is crucial for therapeutic decisions. A good understanding of the tendon's anatomical arrangement in two twisted bundles enables optimal analysis. If several surgical techniques are available, the minimally invasive approach to reinsert the tendon on the radial tuberosity is often preferred. Postoperative assessment includes radiographs, US, and sometimes magnetic resonance imaging, revealing postoperative changes with constant thickening of the repaired tendon. With accurate diagnosis and appropriate surgical technique, surgical repair has a low complication rate. Single-incision repairs show higher rates of re-tears and nerve injuries, and double-incision repairs are prone to heterotopic ossification.

Keywords

distal biceps brachii tendon - rupture - ultrasound - postoperative assessment


Publication History

Article published online:
19 November 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Cucca YY, McLay SVB, Okamoto T, Ecker J, McMenamin PG. The biceps brachii muscle and its distal insertion: observations of surgical and evolutionary relevance. Surg Radiol Anat 2010; 32 (04) 371-375
    CrossrefPubMedSearch in Google Scholar
  • 2 Athwal GS, Steinmann SP, Rispoli DM. The distal biceps tendon: footprint and relevant clinical anatomy. J Hand Surg Am 2007; 32 (08) 1225-1229
    CrossrefPubMedSearch in Google Scholar
  • 3 Jarrett CD, Weir DM, Stuffmann ES, Jain S, Miller MC, Schmidt CC. Anatomic and biomechanical analysis of the short and long head components of the distal biceps tendon. J Shoulder Elbow Surg 2012; 21 (07) 942-948
    CrossrefPubMedSearch in Google Scholar
  • 4 Caetano EB, Vieira LA, Almeida TA, Gonzales LAM, Bona JE, Simonatto TM. Bicipital aponeurosis. Anatomical study and clinical implications. Rev Bras Ortop 2017; 53 (01) 75-81
    CrossrefPubMedSearch in Google Scholar
  • 5 Eames MHA, Bain GI, Fogg QA, van Riet RP. Distal biceps tendon anatomy: a cadaveric study. J Bone Joint Surg Am 2007; 89 (05) 1044-1049
    PubMedSearch in Google Scholar
  • 6 van den Bekerom MPJ, Kodde IF, Aster A, Bleys RLAW, Eygendaal D. Clinical relevance of distal biceps insertional and footprint anatomy. Knee Surg Sports Traumatol Arthrosc 2016; 24 (07) 2300-2307
    CrossrefPubMedSearch in Google Scholar
  • 7 Dirim B, Brouha SS, Pretterklieber ML. et al. Terminal bifurcation of the biceps brachii muscle and tendon: anatomic considerations and clinical implications. AJR Am J Roentgenol 2008; 191 (06) W248-W255
    CrossrefPubMedSearch in Google Scholar
  • 8 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
    CrossrefPubMedSearch in Google Scholar
  • 9 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 (05) 861-865
    CrossrefPubMedSearch in Google Scholar
  • 10 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
    CrossrefPubMedSearch in Google Scholar
  • 11 Giuffre BM, Lisle DA. Tear of the distal biceps branchii tendon: a new method of ultrasound evaluation. Australas Radiol 2005; 49 (05) 404-406
    CrossrefPubMedSearch in Google Scholar
  • 12 Kalume Brigido M, De Maeseneer M, Jacobson JA, Jamadar DA, Morag Y, Marcelis S. Improved visualization of the radial insertion of the biceps tendon at ultrasound with a lateral approach. Eur Radiol 2009; 19 (07) 1817-1821
    CrossrefPubMedSearch in Google Scholar
  • 13 Bourne MH, Morrey BF. Partial rupture of the distal biceps tendon. Clin Orthop Relat Res 1991; (271) 143-148
    PubMedSearch in Google Scholar
  • 14 Kelly MP, Perkinson SG, Ablove RH, Tueting JL. Distal biceps tendon ruptures: an epidemiological analysis using a large population database. Am J Sports Med 2015; 43 (08) 2012-2017
    CrossrefPubMedSearch in Google Scholar
  • 15 Safran MR, Graham SM. Distal biceps tendon ruptures: incidence, demographics, and the effect of smoking. Clin Orthop Relat Res 2002; (404) 275-283
    CrossrefPubMedSearch in Google Scholar
  • 16 Baker BE, Bierwagen D. Rupture of the distal tendon of the biceps brachii. Operative versus non-operative treatment. J Bone Joint Surg Am 1985; 67 (03) 414-417
    CrossrefPubMedSearch in Google Scholar
  • 17 Morrey BF, Askew LJ, An KN, Dobyns JH. Rupture of the distal tendon of the biceps brachii. A biomechanical study. J Bone Joint Surg Am 1985; 67 (03) 418-421
    CrossrefPubMedSearch in Google Scholar
  • 18 Morrey BF. Repair of distal biceps tendon rupture. In: Morrey BF. ed. The Elbow. 3rd ed.. Philadelphia, PA: Wolters Kluwer; 2015: 267-289
    Search in Google Scholar
  • 19 Coulet B, Lazerges C, Chamas M. Les ruptures distales du biceps: Physiopathologie, mécanismes lésionnels, étiologies. In: Mansat P. ed. Les Lésions Distales du Tendon du Biceps Brachial. Montpellier, France: Sauramps Medical; 2010: 15-21
    Search in Google Scholar
  • 20 Hughes JS, Morrey BF. Injury of the flexors of the elbow: biceps tendon injury. In: Morrey BF, Sanchez-Sotelo J. eds. The Elbow and Its Disorders. 4th ed.. Philadelphia, PA: Saunders; 2009: 518-535
    Search in Google Scholar
  • 21 Seiler III JG, Parker LM, Chamberland PDC, 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
    PubMedSearch in Google Scholar
  • 22 Hutchinson HL, Gloystein D, Gillespie M. Distal biceps tendon insertion: an anatomic study. J Shoulder Elbow Surg 2008; 17 (02) 342-346
    CrossrefPubMedSearch in Google Scholar
  • 23 Kannus P, Józsa L. Histopathological changes preceding spontaneous rupture of a tendon. A controlled study of 891 patients. J Bone Joint Surg Am 1991; 73 (10) 1507-1525
    CrossrefPubMedSearch in Google Scholar
  • 24 O'Driscoll SW, Goncalves LBJ, Dietz P. The hook test for distal biceps tendon avulsion. Am J Sports Med 2007; 35 (11) 1865-1869
    CrossrefPubMedSearch in Google Scholar
  • 25 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
    CrossrefPubMedSearch in Google Scholar
  • 26 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 (01) 202-208
    CrossrefPubMedSearch in Google Scholar
  • 27 Brasseur JL. The biceps tendons: from the top and from the bottom. J Ultrasound 2012; 15 (01) 29-38
    CrossrefPubMedSearch in Google Scholar
  • 28 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
    CrossrefPubMedSearch in Google Scholar
  • 29 Brigido MK, De Maeseneer M, Morag Y. Distal biceps brachii. Semin Musculoskelet Radiol 2013; 17 (01) 20-27
    Thieme ConnectPubMedSearch in Google Scholar
  • 30 Champlin J, Porrino J, Dahiya N, Taljanovic M. A visualization of the distal biceps tendon. PM R 2017; 9 (02) 210-215
    CrossrefPubMedSearch in Google Scholar
  • 31 Boyle AB, MacLean SB. Classification system for partial distal biceps tendon tears: a descriptive 3-Tesla magnetic resonance imaging study of tear morphology. Clin Shoulder Elbow 2023; 26 (04) 366-372
    CrossrefPubMedSearch in Google Scholar
  • 32 Lynch J, Yu CC, Chen C, Muh S. Magnetic resonance imaging versus ultrasound in diagnosis of distal biceps tendon avulsion. Orthop Traumatol Surg Res 2019; 105 (05) 861-866
    CrossrefPubMedSearch in Google Scholar
  • 33 Miller TT, Konin GP, Nguyen JT. et al. Ultrasound of the distal biceps brachii tendon using four approaches: reproducibility and reader preference. Skeletal Radiol 2021; 50 (05) 937-943
    CrossrefPubMedSearch in Google Scholar
  • 34 Al-Ani Z, Lauder J. Ultrasound assessment in distal biceps tendon injuries: techniques, pearls and pitfalls. Clin Imaging 2021; 75: 46-54
    CrossrefPubMedSearch in Google Scholar
  • 35 Williams BD, Schweitzer ME, Weishaupt D. et al. Partial tears of the distal biceps tendon: MR appearance and associated clinical findings. Skeletal Radiol 2001; 30 (10) 560-564
    CrossrefPubMedSearch in Google Scholar
  • 36 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 (01) 120-123
    CrossrefPubMedSearch in Google Scholar
  • 37 Idler CS, Montgomery III WH, Lindsey DP, Badua PA, Wynne GF, Yerby SA. Distal biceps tendon repair: a biomechanical comparison of intact tendon and 2 repair techniques. Am J Sports Med 2006; 34 (06) 968-974
    CrossrefPubMedSearch in Google Scholar
  • 38 Kettler M, Lunger J, Kuhn V, Mutschler W, Tingart MJ. Failure strengths in distal biceps tendon repair. Am J Sports Med 2007; 35 (09) 1544-1548
    CrossrefPubMedSearch in Google Scholar
  • 39 Carlier Y. Réinsertion d'une rupture distale du biceps brachial par endobouton versus ancres par voie antérieure. Analyse des résultats à propos d'une série continue de 14 cas [Repair of chronic ruptures of the distal biceps tenon. A report of 14 cases]. Rev Chir Orthoped Traumatol 2017; 103 (08) S252
    PubMedSearch in Google Scholar
  • 40 Sutton KM, Dodds SD, Ahmad CS, Sethi PM. Surgical treatment of distal biceps rupture. J Am Acad Orthop Surg 2010; 18 (03) 139-148
    CrossrefPubMedSearch in Google Scholar
  • 41 Mandegaran R, Crowther S, Jhangri GS, Crowther J, Dhillon S. Western Upper Limb Facility (WULF). Clinical and sonographic evaluation of Endobutton distal biceps brachii tendon repair: what constitutes normal post-operative appearances?. Skeletal Radiol 2020; 49 (07) 1081-1088
    CrossrefPubMedSearch in Google Scholar
  • 42 Créteur V, Madani A, Sattari A, El Kazzi W, Bianchi S. Ultrasonography of complications in surgical repair of the distal biceps brachii tendon. J Ultrasound Med 2019; 38 (02) 499-512
    CrossrefPubMedSearch in Google Scholar
  • 43 Alemann G, Dietsch E, Gallinet D, Obert L, Kastler B, Aubry S. Repair of distal biceps brachii tendon assessed with 3-T magnetic resonance imaging and correlation with functional outcome. Skeletal Radiol 2015; 44 (05) 629-639
    CrossrefPubMedSearch in Google Scholar
  • 44 Cohen M. US imaging in operated tendons. J Ultrasound 2012; 15 (01) 69-75
    CrossrefPubMedSearch in Google Scholar
  • 45 Dunphy TR, Hudson J, Batech M, Acevedo DC, Mirzayan R. Surgical treatment of distal biceps tendon ruptures: an analysis of complications in 784 surgical repairs. Am J Sports Med 2017; 45 (13) 3020-3029
    CrossrefPubMedSearch in Google Scholar
  • 46 Amin NH, Volpi A, Lynch TS. et al. Complications of distal biceps tendon repair: a meta-analysis of single-incision versus double-incision surgical technique. Orthop J Sports Med 2016; 4 (10) 23 25967116668137
    CrossrefPubMedSearch in Google Scholar
  • 47 Matzon JL, Graham JG, Penna S. et al. A prospective evaluation of early postoperative complications after distal biceps tendon repairs. J Hand Surg Am 2019; 44 (05) 382-386
    CrossrefPubMedSearch in Google Scholar
  • 48 Ohliger E, Fei T, Umpierrez E, Ohliger A, Evans P. Dynamic brachial artery entrapment after distal biceps repair: a case report. JBJS Case Connect 2021;11)(01):
    PubMed
  • 49 Carlier Y, Pierreux PA. Primary repair of acute versus chronic ruptures of the distal biceps tendon. Comparison of functional results in a case-control study. Orthop Traumatol Surg Res 2023; 109 (05) 103559
    CrossrefPubMedSearch in Google Scholar
  • 50 Nigro PT, Cain R, Mighell MA. Prognosis for recovery of posterior interosseous nerve palsy after distal biceps repair. J Shoulder Elbow Surg 2013; 22 (01) 70-73
    CrossrefPubMedSearch in Google Scholar
  • 51 Luthringer TA, Bloom DA, Klein DS. et al. Distance of the posterior interosseous nerve from the bicipital (radial) tuberosity at varying positions of forearm rotation: a magnetic resonance imaging study with clinical implications. Am J Sports Med 2021; 49 (05) 1152-1159
    CrossrefPubMedSearch in Google Scholar
  • 52 Besmens IS, Guidi M, Schiller A, Jann D, Giovanoli P, Calcagni M. Management of posterior interosseous nerve (PIN) palsies after distal biceps tendon repair using a single incision technique—a conclusive approach to diagnostics and therapy. J Plast Surg Hand Surg 2021; 55 (04) 226-231
    CrossrefPubMedSearch in Google Scholar
  • 53 Amarasooriya M, Bain GI, Roper T, Bryant K, Iqbal K, Phadnis J. Complications after distal biceps tendon repair: a systematic review. Am J Sports Med 2020; 48 (12) 3103-3111
    CrossrefPubMedSearch in Google Scholar
  • 54 Kim Y, Ha DH, Lee SM. Ultrasonographic findings of posterior interosseous nerve syndrome. Ultrasonography 2017; 36 (04) 363-369
    CrossrefPubMedSearch in Google Scholar
  • 55 Ford SE, Andersen JS, Macknet DM, Connor PM, Loeffler BJ, Gaston RG. Major complications after distal biceps tendon repairs: retrospective cohort analysis of 970 cases. J Shoulder Elbow Surg 2018; 27 (10) 1898-1906
    CrossrefPubMedSearch in Google Scholar
  • 56 Failla JM, Amadio PC, Morrey BF, Beckenbaugh RD. Proximal radioulnar synostosis after repair of distal biceps brachii rupture by the two-incision technique. Report of four cases. Clin Orthop Relat Res 1990; (253) 133-136
    PubMedSearch in Google Scholar
  • 57 Greif DN, Huntley SH, Alidina S. et al. MRI findings of chronic distal tendon biceps reconstruction and associated post-operative findings. Skeletal Radiol 2021; 50 (06) 1095-1109
    CrossrefPubMedSearch in Google Scholar