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Biceps Tendon Injury, Elbow
Kirkland W. Davis, MD, FACR; Andrew Sonin, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Biceps tear, biceps rupture
            • Definitions

              • Biceps tendon injuries include
                • Partial or complete tear or avulsion of distal attachment of biceps brachii tendon
                • Tendinopathy: substantial degeneration of biceps tendon resulting in macroscopic change visible on MR
                • Injury to biceps brachii muscle belly or myotendinous junction, usually due to acute trauma
              • Lacertus fibrosus (a.k.a. biceps aponeurosis): aponeurotic sheath extending from myotendinous junction medially to fascia of anteromedial forearm

            IMAGING

            • General Features

              • MR Findings

                • Ultrasonographic Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • Staging, Grading, & Classification

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  • Image Interpretation Pearls

                                    • Reporting Tips

                                      Selected References

                                      1. Nguyen ML et al: A comprehensive review of the normal, abnormal, and post-operative MRI appearance of the distal biceps brachii. Skeletal Radiol. 49(11):1695-707, 2020
                                      2. Srinivasan RC et al: Distal biceps tendon repair and reconstruction. J Hand Surg Am. 45(1):48-56, 2020
                                      3. Tjoumakaris FP et al: Distal biceps injuries. Clin Sports Med. 39(3):661-72, 2020
                                      4. Créteur V et al: Ultrasonography of complications in surgical repair of the distal biceps brachii tendon. J Ultrasound Med. 38(2):499-512, 2019
                                      5. Spicer PJ et al: Ultrasound in sports medicine. Radiol Clin North Am. 57(3):649-56, 2019
                                      6. Tagliafico AS et al: Elbow US: anatomy, variants, and scanning technique. Radiology. 275(3):636-50, 2015
                                      7. Austin L et al: Distal biceps rupture: the coil sign. Orthopedics. 37(6):e605-7, 2014
                                      8. Blasi M et al: Multidisciplinary approach to the persistent double distal tendon of the biceps brachii. Surg Radiol Anat. 36(1):17-24, 2014
                                      9. Brigido MK et al: Distal biceps brachii. Semin Musculoskelet Radiol. 17(1):20-7, 2013
                                      10. Lobo Lda G et al: The role of sonography in differentiating full versus partial distal biceps tendon tears: correlation with surgical findings. AJR Am J Roentgenol. 200(1):158-62, 2013
                                      11. Schmidt CC et al: The distal biceps tendon. J Hand Surg Am. 38(4):811-21; quiz 821, 2013
                                      12. Brasseur JL: The biceps tendons: from the top and from the bottom. J Ultrasound. 15(1):29-38, 2012
                                      13. Jarrett CD et al: Anatomic and biomechanical analysis of the short and long head components of the distal biceps tendon. J Shoulder Elbow Surg. 21(7):942-8, 2012
                                      14. Stevens K et al: The biceps muscle from shoulder to elbow. Semin Musculoskelet Radiol. 16(4):296-315, 2012
                                      15. Bradshaw AR et al: Distal biceps tendon partial tear presenting as a pseudotumor. J Shoulder Elbow Surg. 20(1):e14-7, 2011
                                      16. Cucca YY et al: The biceps brachii muscle and its distal insertion: observations of surgical and evolutionary relevance. Surg Radiol Anat. 32(4):371-5, 2010
                                      17. Frazier MS et al: Surgical treatment of partial distal biceps tendon ruptures. J Hand Surg Am. 35(7):1111-4, 2010
                                      18. Smith J et al: Sonographic evaluation of the distal biceps tendon using a medial approach: the pronator window. J Ultrasound Med. 29(5):861-5, 2010
                                      19. Tagliafico A et al: Ultrasound demonstration of distal biceps tendon bifurcation: normal and abnormal findings. Eur Radiol. 20(1):202-8, 2010
                                      20. Widmer BJ et al: Treatment of distal biceps tendon ruptures. Am J Orthop (Belle Mead NJ). 39(6):288-96, 2010
                                      21. Koulouris G et al: Bifid insertion of the distal biceps brachii tendon with isolated rupture: magnetic resonance findings. J Shoulder Elbow Surg. 18(6):e22-5, 2009
                                      22. Rineer CA et al: Elbow tendinopathy and tendon ruptures: epicondylitis, biceps and triceps ruptures. J Hand Surg Am. 34(3):566-76, 2009
                                      23. Bain GI et al: Treatment of partial distal biceps tendon tears. Sports Med Arthrosc. 16(3):154-61, 2008
                                      24. Chavan PR et al: Repair of the ruptured distal biceps tendon: a systematic review. Am J Sports Med. 36(8):1618-24, 2008
                                      25. Cohen MS: Complications of distal biceps tendon repairs. Sports Med Arthrosc. 16(3):148-53, 2008
                                      26. Dirim B et al: Terminal bifurcation of the biceps brachii muscle and tendon: anatomic considerations and clinical implications. AJR Am J Roentgenol. 191(6):W248-55, 2008
                                      27. Forthman CL et al: Cross-sectional anatomy of the bicipital tuberosity and biceps brachii tendon insertion: relevance to anatomic tendon repair. J Shoulder Elbow Surg. 17(3):522-6, 2008
                                      28. Hamer MJ et al: Operative treatment of chronic distal biceps tendon ruptures. Sports Med Arthrosc. 16(3):143-7, 2008
                                      29. Hutchinson HL et al: Distal biceps tendon insertion: an anatomic study. J Shoulder Elbow Surg. 17(2):342-6, 2008
                                      30. Mazzocca AD et al: Distal biceps rupture. Orthop Clin North Am. 39(2):237-49, vii, 2008
                                      31. Athwal GS et al: The distal biceps tendon: footprint and relevant clinical anatomy. J Hand Surg Am. 32(8):1225-9, 2007
                                      32. Mazzocca AD et al: The anatomy of the bicipital tuberosity and distal biceps tendon. J Shoulder Elbow Surg. 16(1):122-7, 2007
                                      33. Tran N et al: Ultrasonography of the elbow. Semin Musculoskelet Radiol. 11(2):105-16, 2007
                                      34. Kijowski R et al: Magnetic resonance imaging of the elbow. Part II: abnormalities of the ligaments, tendons, and nerves. Skeletal Radiol. 34(1):1-18, 2005
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Clinical Issues

                                              • Diagnostic Checklist

                                                TERMINOLOGY

                                                • Synonyms

                                                  • Biceps tear, biceps rupture
                                                • Definitions

                                                  • Biceps tendon injuries include
                                                    • Partial or complete tear or avulsion of distal attachment of biceps brachii tendon
                                                    • Tendinopathy: substantial degeneration of biceps tendon resulting in macroscopic change visible on MR
                                                    • Injury to biceps brachii muscle belly or myotendinous junction, usually due to acute trauma
                                                  • Lacertus fibrosus (a.k.a. biceps aponeurosis): aponeurotic sheath extending from myotendinous junction medially to fascia of anteromedial forearm

                                                IMAGING

                                                • General Features

                                                  • MR Findings

                                                    • Ultrasonographic Findings

                                                      • Imaging Recommendations

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • Staging, Grading, & Classification

                                                            CLINICAL ISSUES

                                                            • Presentation

                                                              • Demographics

                                                                • Natural History & Prognosis

                                                                  • Treatment

                                                                    DIAGNOSTIC CHECKLIST

                                                                    • Consider

                                                                      • Image Interpretation Pearls

                                                                        • Reporting Tips

                                                                          Selected References

                                                                          1. Nguyen ML et al: A comprehensive review of the normal, abnormal, and post-operative MRI appearance of the distal biceps brachii. Skeletal Radiol. 49(11):1695-707, 2020
                                                                          2. Srinivasan RC et al: Distal biceps tendon repair and reconstruction. J Hand Surg Am. 45(1):48-56, 2020
                                                                          3. Tjoumakaris FP et al: Distal biceps injuries. Clin Sports Med. 39(3):661-72, 2020
                                                                          4. Créteur V et al: Ultrasonography of complications in surgical repair of the distal biceps brachii tendon. J Ultrasound Med. 38(2):499-512, 2019
                                                                          5. Spicer PJ et al: Ultrasound in sports medicine. Radiol Clin North Am. 57(3):649-56, 2019
                                                                          6. Tagliafico AS et al: Elbow US: anatomy, variants, and scanning technique. Radiology. 275(3):636-50, 2015
                                                                          7. Austin L et al: Distal biceps rupture: the coil sign. Orthopedics. 37(6):e605-7, 2014
                                                                          8. Blasi M et al: Multidisciplinary approach to the persistent double distal tendon of the biceps brachii. Surg Radiol Anat. 36(1):17-24, 2014
                                                                          9. Brigido MK et al: Distal biceps brachii. Semin Musculoskelet Radiol. 17(1):20-7, 2013
                                                                          10. Lobo Lda G et al: The role of sonography in differentiating full versus partial distal biceps tendon tears: correlation with surgical findings. AJR Am J Roentgenol. 200(1):158-62, 2013
                                                                          11. Schmidt CC et al: The distal biceps tendon. J Hand Surg Am. 38(4):811-21; quiz 821, 2013
                                                                          12. Brasseur JL: The biceps tendons: from the top and from the bottom. J Ultrasound. 15(1):29-38, 2012
                                                                          13. Jarrett CD et al: Anatomic and biomechanical analysis of the short and long head components of the distal biceps tendon. J Shoulder Elbow Surg. 21(7):942-8, 2012
                                                                          14. Stevens K et al: The biceps muscle from shoulder to elbow. Semin Musculoskelet Radiol. 16(4):296-315, 2012
                                                                          15. Bradshaw AR et al: Distal biceps tendon partial tear presenting as a pseudotumor. J Shoulder Elbow Surg. 20(1):e14-7, 2011
                                                                          16. Cucca YY et al: The biceps brachii muscle and its distal insertion: observations of surgical and evolutionary relevance. Surg Radiol Anat. 32(4):371-5, 2010
                                                                          17. Frazier MS et al: Surgical treatment of partial distal biceps tendon ruptures. J Hand Surg Am. 35(7):1111-4, 2010
                                                                          18. Smith J et al: Sonographic evaluation of the distal biceps tendon using a medial approach: the pronator window. J Ultrasound Med. 29(5):861-5, 2010
                                                                          19. Tagliafico A et al: Ultrasound demonstration of distal biceps tendon bifurcation: normal and abnormal findings. Eur Radiol. 20(1):202-8, 2010
                                                                          20. Widmer BJ et al: Treatment of distal biceps tendon ruptures. Am J Orthop (Belle Mead NJ). 39(6):288-96, 2010
                                                                          21. Koulouris G et al: Bifid insertion of the distal biceps brachii tendon with isolated rupture: magnetic resonance findings. J Shoulder Elbow Surg. 18(6):e22-5, 2009
                                                                          22. Rineer CA et al: Elbow tendinopathy and tendon ruptures: epicondylitis, biceps and triceps ruptures. J Hand Surg Am. 34(3):566-76, 2009
                                                                          23. Bain GI et al: Treatment of partial distal biceps tendon tears. Sports Med Arthrosc. 16(3):154-61, 2008
                                                                          24. Chavan PR et al: Repair of the ruptured distal biceps tendon: a systematic review. Am J Sports Med. 36(8):1618-24, 2008
                                                                          25. Cohen MS: Complications of distal biceps tendon repairs. Sports Med Arthrosc. 16(3):148-53, 2008
                                                                          26. Dirim B et al: Terminal bifurcation of the biceps brachii muscle and tendon: anatomic considerations and clinical implications. AJR Am J Roentgenol. 191(6):W248-55, 2008
                                                                          27. Forthman CL et al: Cross-sectional anatomy of the bicipital tuberosity and biceps brachii tendon insertion: relevance to anatomic tendon repair. J Shoulder Elbow Surg. 17(3):522-6, 2008
                                                                          28. Hamer MJ et al: Operative treatment of chronic distal biceps tendon ruptures. Sports Med Arthrosc. 16(3):143-7, 2008
                                                                          29. Hutchinson HL et al: Distal biceps tendon insertion: an anatomic study. J Shoulder Elbow Surg. 17(2):342-6, 2008
                                                                          30. Mazzocca AD et al: Distal biceps rupture. Orthop Clin North Am. 39(2):237-49, vii, 2008
                                                                          31. Athwal GS et al: The distal biceps tendon: footprint and relevant clinical anatomy. J Hand Surg Am. 32(8):1225-9, 2007
                                                                          32. Mazzocca AD et al: The anatomy of the bicipital tuberosity and distal biceps tendon. J Shoulder Elbow Surg. 16(1):122-7, 2007
                                                                          33. Tran N et al: Ultrasonography of the elbow. Semin Musculoskelet Radiol. 11(2):105-16, 2007
                                                                          34. Kijowski R et al: Magnetic resonance imaging of the elbow. Part II: abnormalities of the ligaments, tendons, and nerves. Skeletal Radiol. 34(1):1-18, 2005