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 laborers.
The biceps tendon has a fibrous covering (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.
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.
On certain imaging planes, consider partial tearing of the biceps tendon.
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- 3. Giuffrè BM, Moss MJ. Optimal positioning for MRI of the distal biceps brachii tendon: flexed abducted supinated view. AJR Am J Roentgenol. 2004;182 (4): 944-6. AJR Am J Roentgenol (full text) - Pubmed citation
- 4. Miller TT, Adler RS. Sonography of tears of the distal biceps tendon. AJR Am J Roentgenol. 2000;175 (4): 1081-6. doi:10.2214/ajr.175.4.1751081 - Pubmed citation
- 5. Lobo Lda G, Fessell DP, Miller BS et-al. The role of sonography in differentiating full versus partial distal biceps tendon tears: correlation with surgical findings. AJR Am J Roentgenol. 2013;200 (1): 158-62. doi:10.2214/AJR.11.7302 - Pubmed citation
- 6. Fitzgerald SW, Curry DR, Erickson SJ et-al. Distal biceps tendon injury: MR imaging diagnosis. Radiology. 1994;191 (1): 203-6. doi:10.1148/radiology.191.1.8134571 - Pubmed citation
- 7. Sutton KM, Dodds SD, Ahmad CS, Sethi PM. Surgical treatment of distal biceps rupture. (2010) The Journal of the American Academy of Orthopaedic Surgeons. 18 (3): 139-48. Pubmed
Related Radiopaedia articles
- tendon instability
- tendon tear/rupture