Biceps brachii rupture can occur at either superior or inferior attachment but most commonly involves the long head at its proximal origin at the superior glenoid labrum. Rupture of the distal biceps rupture causes weakness when supinating the forearm. It is therefore associated with significant functional loss, especially in labourers.
The biceps tendon has a fibrous covering (the lacertus fibrosus) that can clinically feel similar to an intact tendon even though the distal biceps tendon has torn.
Trauma-related injury involves the distal part, which is rare and seen in young people. Degenerative causes involve the proximal part of the tendon.
MR imaging features that can help diagnose ruptures include 1:
- depiction of the absence of the tendon distally
- fluid-filled tendon sheath: can be found in most cases 1
- antecubital fossa mass
- muscle edema: non-specific
- muscle atrophy: non-specific
A flexed abducted supinated view or FABS position is considered an optimal position for the assessment of a distal biceps brachii tendons 3.
On certain imaging planes consider
- partial tearing of biceps tendon
Treatment and prognosis
Ruptures of the distal biceps tendon are usually treated surgically. This involves reattaching the tendon to the radial tuberosity. There are numerous acceptable surgical techniques for this procedure 7.
Early surgical intervention is recommended. Delay to diagnosis and treatment is associated with retraction of the tendon. If this is to occur, a reconstruction rather than a repair is indicated.
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