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
Treatment and prognosis
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
- 1. Stoller D, Tirman P, Bredella M et-al. Diagnostic imaging. AMIRSYS. (2004) ISBN:0721629202. Read it at Google Books - Find it at Amazon
- 2. Sofka CM, Adler RS. Sonography of cubital bursitis. AJR Am J Roentgenol. 2004;183 (1): 51-3. doi:10.2214/ajr.183.1.1830051 - Pubmed citation
- 3. Skaf AY, Boutin RD, Dantas RW et-al. Bicipitoradial bursitis: MR imaging findings in eight patients and anatomic data from contrast material opacification of bursae followed by routine radiography and MR imaging in cadavers. Radiology. 1999;212 (1): 111-6. Radiology (full text) - Pubmed citation
- 4. Kegels L, Van Oyen J, Siemons W et-al. Bicipitoradial bursitis. A case report. Acta Orthop Belg. 2006;72 (3): 362-5. Pubmed citation
- 5. Yap S et.al. Imaging bicipitoradial bursitis: a pictorial essay. (2019) Skeletal radiology. doi:10.1007/s00256-018-2970-0 - Pubmed
- 6. Draghi F, Gregoli B, Sileo C. Sonography of the bicipitoradial bursa: A short pictorial essay. (2012) Journal of ultrasound. 15 (1): 39-41. doi:10.1016/j.jus.2012.02.003 - Pubmed
- 7. Choi Tsz-Lung, Lui Tun-Hing. Bicipitoradial Bursitis: A Review of Clinical Presentation and Treatment:. (2014) Journal of Orthopaedics, Trauma and Rehabilitation. doi:10.1016/j.jotr.2013.12.009
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