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Age / Sex : 50 / M
Chief complaint: Pain of right elbow
What is your impression?
Two weeks later, you can see the final diagnosis with a brief discussion of this case. (Please submit only one answer)
Courtesy: Yun Sun Choi, MD,
Eulji Hospital, Eulji University
Diagnosis: Biceps tendon tear
Discussion
Findings:
Sagittal PD-weighted and axial fat-suppressed
T2-weighted FSE MR images show a completely torn and retracted biceps tendon with
peritendinous fluid. Biceps aponeurosis is also torn.
Differential Diagnosis:
1.
Biceps
mass
2.
Brachialis
strain
Diagnosis:
Biceps tendon tear (rupture, avulsion)
Discussion:
Rupture of the distal
biceps tendon is rare. Recently, however, this disorder is becoming
increasingly common, especially in middle aged men. Complete tears of the
distal biceps are thought to be much more common than partial tears.
Differentiation of complete from partial tears
is sometimes difficult clinically, particularly if the bicipital aponeurosis (lacertus fibrosus) remains intact. Precise delineation of the
extent of the abnormality can aid in the management of complete tears without
retraction or of partial tears. Most tears occur 1–2 cm above the radial
tuberosity, where there is relative hypovascularity and a histologic structural
transition point. Retraction occurs only if the lacertus fibrosus is
torn. Although flexion power at the elbow may be preserved with an intact
lacertus fibrosus, supination of the forearm usually is weakened due to the
biceps tendon detachment from the radial tuberosity. Pre-tear tendinosis may be
accompanied by significant biceps bursal effusion. US, particularly dynamic imaging, can be used to confirm
continuity of the tendon or the abnormal movement of a disconnected proximal
tendon, but this region is not always well demonstrated. MRI is also useful in diagnosing
biceps tears. There should be sagittal coverage to 10 cm proximal to the joint
line to look for a retracted tendon.
References:
1. Chew ML, Giuffrè BM.
Disorders of the distal biceps brachii tendon.
Radiographics.
2005;25(5):1227-1237
2. Blease S, Stoller DW, Safran MR, Li AE, Fritz RC. The elbow. In
Stoller DW ed. Magnetic resonance imaging in orthopedics and sports medicine,
3rd ed. Philadelphia: Lippincott Williams and Wilkins, 2007:1592-1598
3.
Resnick D, Kang HS,
Pretterklieber ML. Internal derangements of joints, 2nd ed.
Philadelphia: Saunders, 2007:1165-1172
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