Magnetic resonance imaging versus ultrasound in diagnosis of distal biceps tendon avulsion

Lynch, Jonathan R.; Chen, Chaoyang; Muh, Stephanie J.

doi:10.1016/j.otsr.2019.01.021

Cited by 16 publications

(14 citation statements)

References 23 publications

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“…According to the comparative study of Lynch et al, MRI has a better diagnostic accuracy than US for the diagnosis of a complete DBBT tear. The authors found a similar diagnostic accuracy for the diagnosis of an incomplete DBBT tear [3]. MRI is thus considered as the gold standard in the diagnosis of the DBBT injury and is especially useful in diagnosing complete DBBT tears and for assessment of the extent of tendon retraction, the condition of the lacertus fibrosis and to locate the torn tendon stump in complete DBBT tears.…”

mentioning

confidence: 74%

Distal Biceps Brachii Tendon Injuries: An Imaging Update

Pinas

Nijs

Shahabpour

2021

Journal of the Belgian Society of Radiology

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mentioning

confidence: 74%

Distal Biceps Brachii Tendon Injuries: An Imaging Update

Pinas

Nijs

Shahabpour

2021

Journal of the Belgian Society of Radiology

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“…4 For partial tears, the overall accuracy rate of MRI (66.7%) was the same as ultrasound, but MRI had a low sensitivity (59.1%) but a high specificity (100%). 8,15 The main strengths of our study are provided by the fact that it is the largest prospectively collected sample of patients with distal biceps pathology, including both acute and chronic, complete and partial ruptures, as well as tendinitis and other anterior elbow complaints. Using a combination of tests provided even more reliable results, with the ability to more accurately discern between acute and chronic complete ruptures.…”

Section: Discussionmentioning

confidence: 99%

Distal Biceps Tendon Ruptures: Diagnostic Strategy Through Physical Examination

et al. 2022

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Background: Distinguishing a complete from a partial distal biceps tendon rupture is essential, as a complete rupture may require repair on short notice to restore function, whereas partial ruptures can be treated nonsurgically in most cases. Reliability of physical examination is crucial to determine the right workup and treatment in patients with a distal biceps tendon rupture. Purposes: The primary aim of this study was to find a (combination of) test(s) that serves best to diagnose a complete rupture with certainty in the acute phase (≤1 month) without missing any complete ruptures. The secondary aims were to determine the best (combination of) test(s) to identify a chronic (>1 month) rupture of the distal biceps tendon and indicate additional imaging in case partial ruptures or tendinitis are suspected. Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: A total of 86 patients with anterior elbow complaints or suspected distal biceps injury underwent standardized physical examination, including the Hook test, passive forearm pronation test, biceps crease interval (BCI), and biceps crease ratio. Diagnosis was confirmed intraoperatively (68 cases), by magnetic resonance imaging (13 cases), or by ultrasound (5 cases). Results: A combination of the Hook test and BCI (ie, both tests are positive) was most accurate for both acute and chronic ruptures but with a different purpose. For acute complete ruptures, sensitivity was 94% and specificity was 100%. In chronic cases, specificity was also 100%. Weakness on active supination and palpation of the tendon footprint provided excellent sensitivity of 100% for chronic complete ruptures and partial ruptures, respectively. Conclusion: The combination of a positive Hook test and BCI serves best to accurately diagnose acute complete ruptures of the distal biceps tendon. Weakness on active supination and pain on palpation of the tendon footprint provide excellent sensitivity for chronic complete ruptures and partial ruptures. Using these tests in all suspected distal biceps ruptures allows a physician to refrain from imaging for a diagnostic purpose in certain cases, to limit treatment delay and thereby provide better treatment outcome, and to avoid hospital and social costs.

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“… 25 , 26 Although MRI has limitations, studies have shown it has a relatively high sensitivity and specificity, especially for complete tears, and it is more accurate than ultrasound in detecting a tear. 24 , 27 Festa et al. 24 looked at MRI accuracy in diagnosing distal biceps ruptures and found that MRI has 100% sensitivity and 82% specificity for complete ruptures.…”

Section: Discussionmentioning

confidence: 99%

The Flexion Initiation Test and an Evidence-Based Diagnostic Algorithm for Distal Biceps Tendon Tears

Bono

Shah

Peterson³

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose The purpose of this study was (1) to assess the flexion initiation test’s (FIT) ability to detect distal biceps tendon tears (DBTT) in a cohort of consecutive patients presenting with elbow pain and (2) to generate a reliable evidence-based diagnostic algorithm using a combination of both the FIT and hook tests. Methods We performed a retrospective review of 125 consecutive patients who presented with elbow pain, all of which had the FIT and hook test performed prior to imaging/further intervention. The integrity of the tendon was determined during surgery or by magnetic resonance imaging. Sensitivity, specificity, positive predictive value, and negative predictive value were determined for the FIT and hook test. Results Our evidence-based diagnostic algorithm showed that when both test results are in agreement, there is a 100% diagnostic accuracy for detecting what prior authors have termed surgically indicated tears (complete ruptures and high-grade partial tears) and biceps pathology that can be treated with nonoperative management. The FIT demonstrated 100% sensitivity for surgically indicated tears. The hook test demonstrated 100% sensitivity for complete ruptures, but 18% sensitivity for diagnosing partial tears. Conclusions The FIT, which is aimed at improving diagnostic acuity of high-grade partial thickness tears, demonstrated a 93% sensitivity and 96% specificity overall and a 100% sensitivity for complete ruptures and high-grade partial tears. The evidence-based diagnostic algorithm using the combination of the FIT and hook test demonstrates high accuracy for the diagnosis of both complete and high-grade partial DBTTs. The methodology may help to prevent diagnosis delays, improve patient education, and preserve the option for timely primary surgical repair in the treatment of DBTTs. Level of Evidence Level IV, diagnostic.

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Magnetic resonance imaging versus ultrasound in diagnosis of distal biceps tendon avulsion

Cited by 16 publications

References 23 publications

Distal Biceps Brachii Tendon Injuries: An Imaging Update

Distal Biceps Brachii Tendon Injuries: An Imaging Update

Distal Biceps Tendon Ruptures: Diagnostic Strategy Through Physical Examination

The Flexion Initiation Test and an Evidence-Based Diagnostic Algorithm for Distal Biceps Tendon Tears

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