Bicipitoradial bursitis

Last revised by Dr Yuranga Weerakkody on 17 Aug 2020

Bicipitoradial bursitis refers to inflammation of the bicipitoradial bursa

The bicipitoradial bursa surrounds the biceps tendon in supination. In pronation, the radial tuberosity rotates posteriorly, which compresses the bicipitoradial bursa between the biceps tendon and the radial cortex, which consequently increases the pressure within the bursa.

It typically presents in adults and may be more common in males.

Patients often present with elbow swelling, pain, tenderness, redness, and limited movement.

Most often results from repetitive mechanical trauma or overuse 7. Other less common causes include tuberculosis, synovial chondromatosis. and immunological complications of rheumatological disease. 

There may be evidence of distention of the bicipitoradial bursa by fluid, which appears anechoic, or hypoechoic soft tissue. Nodular soft-tissue debris and small calcifications may be seen within the fluid. The distal biceps tendon should be evaluated for injury. Power Doppler imaging may show hyperemia and suggests active inflammation.

Features observed on different sequences include

  • T1: homogeneous hypointense signal mass in characteristic location; associated tendinosis of biceps tendon, thickening and intermediate signal intensity at insertion
  • T2: hyperintense flattened, oval, or round shaped cystic appearing mass that shows fluid signal intensity on all pulse sequences unless containing inflammatory debris or calcification +/- rice bodies in patients with rheumatoid arthritis
  • STIR: as with T2 with more homogeneous fat saturation
  • T1 C+ (Gd): may demonstrate thin rim enhancement after gadolinium administration and homogeneous low central signal intensity

Management options include

  • acute: rest, antibiotics, nonsteroidal antiinflammatory drugs, and aspiration of infected fluid
  • chronic: splinting and removal of foreign bodies

General imaging differential considerations include

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Cases and figures

  • Figure 1: bicipitoradial bursa
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  • Case 1
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  • Case 2
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  • Case 3: on ultrasound
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