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 presents with elbow swelling, pain, tenderness, redness and limited movement.
May show evidence of distention of the bicipitoradial bursa by fluid which appear anechoic or hypoechoic soft tissue. The distal biceps tendon should be evaluated for injury. Nodular soft-tissue debris and small calcifications may be seen within the fluid. Power Doppler imaging may show hyperaemia 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
Treatment and prognosis
Management options include
- acute: rest, antibiotics, NSAIDs and aspiration of infected fluid
- chronic: splinting and removal of foreign bodies
General imaging differential considerations include
- biceps tendon tear or tendinosis
- posterior elbow dislocation
- osteochondritis dissecans of the capitulum
- radial head fracture
- other causes of antecubital mass, e.g. lipoma, hematoma, neuroma
- elbow anatomy
- elbow radiography
- MRI of the elbow - an approach
- distal humeral fracture
- Panner disease (osteochondrosis of the capitellum)
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