Biceps Tendon Injuries

Distal biceps tendon rupture most commonly occurs in the dominant extremity of males between 40 and 60 years of age. Rupture of the distal biceps tendon may be partial or complete. Rupture of the distal biceps tendon almost always is the result of a single traumatic event in which a sudden extension force is applied to the arm with the elbow flexed 90 degrees. Most tears of the distal biceps tendon occur at the insertion site of the tendon into the radial tuberosity. Intrasubstance tears and tears at the musculotendinous junction of the distal biceps tendon have been reported but are rare. The bicipital aponeurosis may or may not tear during rupture of the distal biceps tendon. If the bicipital aponeu-rosis is torn, the ruptured distal biceps tendon retracts proximally into the arm

MRI can be used to evaluate individuals with distal biceps tendon injuries. Although a completely torn and retracted distal biceps tendon is recognized easily on physical examination, a partially torn or completely torn but nonretracted distal biceps tendon may be difficult to diagnose clinically. MRI has been shown to be helpful at confirming the presence of a distal biceps tendon injury and distinguishing between partial and complete biceps tendon rupture [60,6l].

The distal biceps tendon is evaluated best on axial MRI images. Complete tendon rupture is characterized by the absence of the low signal intensity distal biceps tendon at its insertion site on the radial tuberosity and by the presence of soft tissue edema within the antecubital fossa. A variable amount ofretraction of the distal biceps tendon usually is noted on sagittal images. (Fig. 18) [58,59]. Partial tendon rupture is characterized by the presence of increased signal intensity within an abnormally thickened or thinned distal biceps tendon [50-52]. It often is difficult to distinguish between tendinopathy and partial rupture of the distal biceps tendon on MRI [59,62]. Secondary findings of a partially torn distal biceps tendon include the presence of bone marrow edema within the radial tuberosity and the presence of fluid within the bicipitoradial bursa [44].

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