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Ultraschall Med 2005; 26(1): 17-23
DOI: 10.1055/s-2004-813718
Originalarbeit

© Georg Thieme Verlag KG Stuttgart · New York

Sonographic Imaging of the Distal Biceps Tendon - An Experimental and Clinical Study

Die sonographische Darstellbarkeit der distalen Bizepssehne - eine experimentelle und klinische StudieR. Kayser1, 4 , K. Mahlfeld1 , W. Scheller2 , J. Müller3 , W. Schmidt2 , C. E. Heyde4
  • 1Department of Orthopedics, “Otto-von-Guericke”-University Magdeburg, Germany
  • 2Institute of Anatomy, University of Leipzig, Germany
  • 3Department of Radiology, University of Leipzig, Germany
  • 4Charité - University Medicine Berlin, Campus Benjamin Franklin, Department of Trauma and Reconstructive Surgery, Germany
Further Information

Publication History

received: 8.12.2003

accepted: 2.8.2004

Publication Date:
07 February 2005 (online)

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Zusammenfassung

Studienziel: Es sollte geprüft werden, ob sich mit der Sonographie die distale Bizepssehne an humanen Leichenpräparaten und an freiwilligen Probanden sicher darstellen lässt. Methode: Zunächst erfolgte die sonographische Darstellung der distalen Bizepssehne einschließlich der sonographisch kontrollierten perkutanen Markierung der Sehne mittels Kanüle an sechs humanen Ganzarmpräparaten. Anschließend untersuchten wir an 25 freiwilligen Probanden die distale Bizepssehne sonographisch (50 Sonogramme). Alle Untersuchungen wurden mit unterschiedlich frequenten Linearschallköpfen (5 bis 13,5 MHz) durchgeführt. Die Sonogramme wurden von zwei erfahrenen Untersuchern unabhängig voneinander bewertet. Resultate: Die Identifizierung der Sehne gelang in allen Fällen. Die besten Resultate wurden mit dem 7,5-MHz-Schallkopf erreicht. Unsere Studie zeigt weiterhin, dass innerhalb der Standardebenen insbesondere ein medianer Längsschnitt und transversale Schnitte in Höhe des Gelenkspalts zur korrekten Beurteilung der distalen Bizepssehne notwendig sind. Eine dynamische Untersuchung ist zur exakten Beurteilung der Sehne immer zu empfehlen. Schlussfolgerung: Bei ausreichender Erfahrung des Untersuchers ist die Sonographie als diagnostisches Verfahren zur Darstellung der distalen Bizepssehne als Mittel der ersten Wahl anzusehen.

Abstract

Aim: With this study we aimed to determine the reliability of ultrasound imaging in depicting the normal anatomy of the distal biceps tendon in human cadaver specimens and to provide an accurate visualisation of ruptures of the distal biceps tendon in healthy volunteers. Method: The distal biceps tendons of six whole-arm human cadaver specimens were investigated. The tendons were subsequently marked with a biopsy needle and re-examined. In addition, ultrasound imaging of the distal biceps tendon was performed in 25 healthy volunteers (50 sonograms). All examinations were carried out using linear ultrasonic transducers of various frequencies (5 - 13.5 MHz). The sonographic images were submitted to two experienced examiners for analysis. Results: Positive identification of the tendon was achieved in all cases. The best results were achieved using 7.5 MHz transducers. Our study also suggests that the medial longitudinal scan and the articular transversal scan are a definite prerequisite for a correct diagnosis in the region of the distal biceps tendon. The dynamic examination is very useful to visualise the tendon with sufficient accuracy. Conclusion: Based on this study, ultrasound imaging is recommended as the method of choice for visualisation of the distal biceps tendon if performed with the necessary accuracy.

Schlüsselwörter

Distale Bizepssehne - Bizepssehnenruptur - Ellenbogengelenk - Ultraschall - standardisierte sonographische Untersuchung

Key words

Distal biceps tendon - elbow joint - ultrasound - sonography - standardised ultrasound examination

References

  • 1 Middleton W D, Reinus W R, Totty W G. et al . Ultrasonographic evaluation of the rotator cuff and the long biceps tendon.  J Bone Joint Surg (Am). 1986;  68 440-450
    PubMedSearch in Google Scholar
  • 2 Wülker N, Kohn D. Routine ultrasound diagnosis of the shoulder. A simplified examination procedure.  Ultraschall Med. 1991;  12 228-235
    PubMedSearch in Google Scholar
  • 3 Leotta D F, Martin R W. Three-dimensional ultrasound imaging of the rotator cuff: spatial compounding and tendon thickness measurement.  Ultrasound Med Biol. 2000;  26 509-525
    CrossrefPubMedSearch in Google Scholar
  • 4 d’Allessandro D F, Shields J r CL, Tibone J E. et al . Repair of distal biceps tendon ruptures in athletes.  Am J Sports Med. 1993;  21 114-119
    PubMedSearch in Google Scholar
  • 5 Safran M R, Graham S M. Distal biceps tendon ruptures - Incidence, demographics and the effect of smoking.  Clin Orthop. 2002;  402 275-283
    PubMedSearch in Google Scholar
  • 6 Rantanen J, Orava S. Rupture of the biceps tendon. A report of 19 patients treated with anatomic reinsertion, and a metaanalysis of 147 cases found in the literature.  Am J Sports Med. 1999;  27 128-132
    CrossrefPubMedSearch in Google Scholar
  • 7 Dobbi R B. Avulsion of the lower biceps brachii tendon: Analysis of fifty-one previously unreported cases.  Am J Surg. 1941;  51 662-683
    CrossrefPubMedSearch in Google Scholar
  • 8 Klonz A, Reilmann H. Biceps tendon: diagnosis, therapy and results after proximal and distal rupture.  Orthopäde. 2000;  29 209-215
    CrossrefPubMedSearch in Google Scholar
  • 9 Dürr R, Stäbler A, Pfahler M. et al . Partial rupture of the distal biceps tendon.  Clin Orthop. 2000;  374 195-200
    PubMedSearch in Google Scholar
  • 10 Gilchreest E L, Albi P. Unusual lesions of muscles and tendons of the shoulder girdle and upper arm.  Surg Gynecol Obstet. 1939;  68 903-917
    PubMedSearch in Google Scholar
  • 11 Wirth C J. The elbow. Wirth CJ Practise of orthopaedics Stuttgart; Thieme 2001 Vol. 2: 361-362
    Search in Google Scholar
  • 12 Miller T T, Adler R S. Sonography of tears of the distal biceps tendon.  Am J Roentgenol. 2000;  175 1081-1086
    PubMedSearch in Google Scholar
  • 13 Sotje G, Besch L. Distal rupture of the biceps tendon - a magnetic resonance tomography follow up.  Aktuelle Traumatol. 1993;  23 105-107
    PubMedSearch in Google Scholar
  • 14 Falcock F S, Zlatki M B, Erbacher G E. Rupture of the distal biceps tendon: evaluation with MR imaging diagnosis.  Radiology. 1994;  190 659-663
    PubMedSearch in Google Scholar
  • 15 Fitzgerald S W, Curry D R, Scott J E. Distal biceps tendon injury. MR imaging diagnosis.  Radiology. 1994;  191 203-206
    PubMedSearch in Google Scholar
  • 16 Le H uec JC, Moinard M, Liquois F. Distal ruptures of the tendon of the biceps brachii: evaluation by MRI and the results of repair.  J Bone Joint Surg Br. 1996;  78 767-770
    PubMedSearch in Google Scholar
  • 17 Logan P M, Janzen D L, Connell D G. Tear of the biceps tendon presenting as an antecubital mass: magnetic resonance imaging appearances.  Can Assoc Radiol J. 1996;  47 342-346
    PubMedSearch in Google Scholar
  • 18 Williams B D, Schweitzer M E, Weishaupt D. et al . Partial tears of the distal biceps tendon: MR appearance and associated clinical findings.  Skeletal Radiol. 2001;  30 560-564
    CrossrefPubMedSearch in Google Scholar
  • 19 Lozano V, Alonso P. Sonographic detection of the distal biceps tendon rupture.  J Ultrasound Med. 1995;  14 389-391
    PubMedSearch in Google Scholar
  • 20 Belli P, Costantini M, Mirk P. et al . Sonographic diagnosis of biceps tendon rupture.  J Ultrasound Med. 2001;  20 587-595
    CrossrefPubMedSearch in Google Scholar
  • 21 Johnson S. Avulsion of biceps tendon from the radius.  N Y Med J. 1897;  66 261-262
    PubMedSearch in Google Scholar
  • 22 Boyd M M, Anderson L D. A method of reinsertion of the biceps brachii tendon.  J Bone Joint Surg Am. 1961;  43 1041-1043
    PubMedSearch in Google Scholar
  • 23 Louis D S, Hankin F M, Eckenrode J F. Distal biceps brachii tendon avulsion. A simplified method of operative repair.  Am J Sports Med. 1986;  14 234-236
    PubMedSearch in Google Scholar
  • 24 Levy H J, Mashoof A, Morgan D. Repair of chronic ruptures of the distal biceps tendon using flexor carpi radialis tendon graft.  Am J Sports Med. 2000;  28 538-540
    CrossrefPubMedSearch in Google Scholar
  • 25 Strauch R J, Michaelson H, Rosenwasser M P. Repair of rupture of the distal biceps brachii. Review of the literature and report of three cases treated with a single anterior incision and suture anchors.  Am J Orthop. 1997;  26 151-156
    PubMedSearch in Google Scholar
  • 26 Rantanen J, Orava S. Rupture of the biceps tendon. A report of 19 patients treated with anatomic reinsertion, and a metaanalysis of 147 cases found in the literature.  Am J Sports Med. 1999;  27 128-132
    CrossrefPubMedSearch in Google Scholar
  • 27 Catonne Y, Delattre O, Pascal-Mousselard H. et al . Rupture of the distal tendon of the biceps brachialis: apropo of 43 cases.  Rev Chir Orthop Reparatrice Appar Mor. 1995;  81 163-172
    PubMedSearch in Google Scholar
  • 28 Thiel W. The preservation of the whole corpse with natural color.  Ann Anat. 1992;  174 185-195
    CrossrefPubMedSearch in Google Scholar
  • 29 Konermann W, Gruber G. Standard ultrasound sections of the upper extremity -shoulder and elbow joint.  Ultraschall Med. 1998;  19 130-138
    Thieme ConnectPubMedSearch in Google Scholar
  • 30 Weiss C, Mittelmeier M, Gruber G. Do we need MR images for diagnosing tendon ruptures of the distal biceps brachii? The value of ultrasonographic imaging.  Ultraschall Med. 2000;  21 284-286
    Thieme ConnectPubMedSearch in Google Scholar

Dr. med. Ralph Kayser

Charité - University Medicine Berlin, Campus Benjamin Franklin, Department of Trauma and Reconstructive Surgery

Hindenburgdamm 30

12200 Berlin, Germany

Phone: ++ 49/30/84 45 48 48

Fax: ++ 49/30/84 45 44 64

Email: Ralph.Kayser-Berlin@t-online.de