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Ultrasound of the elbow with emphasis on the sonoanatomy of the distal biceps tendon and its importance for the surgical treatment of tendon lesions

Giorgio Tamborrini
Giorgio Tamborrini
, 
Magdalena Müller-Gerbl
Magdalena Müller-Gerbl
, 
Nicole Vogel
Nicole Vogel
 et 
David Haeni
David Haeni
   | 15 juin 2020
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Article Category: research-article
Publié en ligne: 15 juin 2020
Pages: 129 - 134
Reçu: 22 janv. 2020
Accepté: 16 avr. 2020
DOI: https://doi.org/10.15557/jou.2020.0021
Mots clés
© 2021 Polish Ultrasound Society. Published by Medical Communications Sp. z o.o.
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Fig. 1.

Anterior elbow, transverse image in supination, B-mode, 11 MHz. *1 – cortical bone, trochlea humeri, *2 – hyaline cartilage, *3 – joint capsule, *4 – brachioradialis muscle, *5 – brachialis muscle, *6 – pronator teres muscle, *7 – joint cavity, >1 – distal biceps tendon (long head), >2 – distal biceps tendon (short head), >3 – lacertus fibrosus, >4 – brachial artery, >5 – veins, yellow arrow – radial nerve, orange arrow – median nerve
Anterior elbow, transverse image in supination, B-mode, 11 MHz. *1 – cortical bone, trochlea humeri, *2 – hyaline cartilage, *3 – joint capsule, *4 – brachioradialis muscle, *5 – brachialis muscle, *6 – pronator teres muscle, *7 – joint cavity, >1 – distal biceps tendon (long head), >2 – distal biceps tendon (short head), >3 – lacertus fibrosus, >4 – brachial artery, >5 – veins, yellow arrow – radial nerve, orange arrow – median nerve

Fig. 2.

Anterior/medial elbow, longitudinal image, B-Mode, 11 MHz >1 – distal biceps tendon (long head), >2 – distal biceps tendon (short head), >3 – lacertus fibrosus, *1 – radius, *2 – biceps muscle, long head, *3 – pronator teres muscle
Anterior/medial elbow, longitudinal image, B-Mode, 11 MHz >1 – distal biceps tendon (long head), >2 – distal biceps tendon (short head), >3 – lacertus fibrosus, *1 – radius, *2 – biceps muscle, long head, *3 – pronator teres muscle

Fig. 3.

Posterior/lateral elbow, longitudinal image in maximal pronation, B-Mode, 11 MHz. >1 – distal biceps tendon (long head), >2 – distal biceps tendon (short head), *1 – insertion of the long head of the biceps tendon at the footprint/radial tuberosity, *2 – insertion of the short head of the biceps tendon at the footprint/radial tuberosity, *3 – radial head, *4 – supinator muscle, *5 – flexor carpi radialis muscle
Posterior/lateral elbow, longitudinal image in maximal pronation, B-Mode, 11 MHz. >1 – distal biceps tendon (long head), >2 – distal biceps tendon (short head), *1 – insertion of the long head of the biceps tendon at the footprint/radial tuberosity, *2 – insertion of the short head of the biceps tendon at the footprint/radial tuberosity, *3 – radial head, *4 – supinator muscle, *5 – flexor carpi radialis muscle

Fig. 4.

Posterior/lateral elbow, transverse image in maximal pronation, B-Mode, 11 MHz. >1 – distal biceps tendon, *1 – insertion of the distal biceps tendon at the footprint / radial tuberosity, *2 – ulna, *3 – extensor digitorum communis muscle, *4 – supinator muscle, *5 – extensor carpi ulnaris muscle, *6 – anconeus muscle
Posterior/lateral elbow, transverse image in maximal pronation, B-Mode, 11 MHz. >1 – distal biceps tendon, *1 – insertion of the distal biceps tendon at the footprint / radial tuberosity, *2 – ulna, *3 – extensor digitorum communis muscle, *4 – supinator muscle, *5 – extensor carpi ulnaris muscle, *6 – anconeus muscle

Fig. 5.

Anterior elbow, coronar scan, B-mode, 11 MHz. *1 – radial artery, *2 – median nerve, >1 – normal fibers of the distal biceps tendon, white arrows – partial tear of the distal biceps tendon (arrows) with inhomogeneous bicipitoradial bursitis
Anterior elbow, coronar scan, B-mode, 11 MHz. *1 – radial artery, *2 – median nerve, >1 – normal fibers of the distal biceps tendon, white arrows – partial tear of the distal biceps tendon (arrows) with inhomogeneous bicipitoradial bursitis

Fig. 6.

Refixation of the distal biceps tendon: schematic illustration and postoperative x-ray showing the anchors at the radial tuberosity
Refixation of the distal biceps tendon: schematic illustration and postoperative x-ray showing the anchors at the radial tuberosity

Pathologies detectable by high-resolution ultrasound (18)

• Mechanical enthesopathy
• Inflammatory enthesitis
• Calcifications in the tendon or the enthesis
• Neovascularization, e.g. by means of B-flow examination
• Cubital bursitis (bizipitoradial bursitis)
• Interosseous bursitis
• Tendinosis (usually 1–2 cm proximal)
• Partial ruptures
• Complete ruptures
• Avulsions with osseous tearing
• Postoperative assessment with evaluation of tendon integrity, anchor position, suture position
• Determination of tendon elasticity using elastography
• Mechanical impingement during pronation-supination
• Secondary irritation caused by enthesophytes, osteophytes or by articular pathologies (synovitis, activated cubital arthrosis, synovial chondromatosis, etc.)
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