Distal Biceps Brachii Tendon Insertion

Abstract

Different ultrasound approaches have been proposed to evaluate the distal biceps brachii tendon, such as lateral, posterior, medial, and anterior, all allowing good visualization of the distal biceps tendon and its pathologic appearances. Here we describe a new method of ultrasound evaluation of the distal biceps tendon insertion with the patient in the so‐called crab position. The crab position is used to evaluate the posterior compartment of the elbow but also the lateral and medial compartments. This position allows for coverage of 75% the elbow in a single position, with less discomfort for the patient and a fair amount of saved time. In this position, after the evaluation of the common extensor tendon in the long axis, turning the transducer 90° and moving it distally allows for optimal visualization of the distal biceps brachii tendon in the axial plane. It is a simple, quick approach that allows for excellent visualization of the insertion of the distal biceps brachii tendon while avoiding an anisotropic effect.

Ultrasound assessment of distal biceps tendon injuries

“…Ultrasound is a cost-effective and convenient study that has been proven to be accurate in its assessment of the distal biceps tendon. 4,7,8 Unfortunately, orthopaedic surgeons do not regularly use ultrasound to evaluate musculoskeletal injuries. 10 Because ultrasound is operator-dependent, it is understandable that orthopaedic surgeons would shy away from performing these procedures.…”

“…Several studies have demonstrated the effective use of ultrasound to diagnose distal biceps tendon injuries; however, ultrasound is operator-dependent 4,6,7. Classically, four different approaches to evaluate the distal biceps tendon exist: anterior, medial, lateral, and posterior.…”

“…Several studies have demonstrated the effective use of ultrasound to diagnose distal biceps tendon injuries; however, ultrasound is operator-dependent. 4,6,7 Classically, four different approaches to evaluate the distal biceps tendon exist: anterior, medial, lateral, and posterior. There is no consensus regarding the best approach, but rather, combined use of all approaches help enhance the accuracy of the evaluation.…”

“…8 Despite this idea, Miller et al 9 reviewed the four different approaches to evaluate the distal biceps tendon using ultrasound and found that readers and operators significantly preferred the medial approach (P < 0.001) among the others. Conversely, while describing a new method of ultrasound evaluation of the distal biceps tendon using the crab position, Draghi et al 7 stated that the anterior approach with the forearm pronated was the most commonly used. Obviously, operator preference and experience influence the preferred approach.…”

“…After the evaluation of the common extensor tendon in the long axis, the transducer is turned 90 degrees and moved distally, allowing a view of the distal biceps tendon in the transverse plane. 7 Use of ultrasound to evaluate the distal biceps tendon can be challenging, but using consistent steps and approaches, accurate assessment can be obtained. This article presents a simple and reproducible technique to evaluate the distal biceps tendon using ultrasound.…”