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DISTAL BICEPS TENDON: DOUBLE TROUBLE

Distal Biceps Tendon Anatomy and Pathology

 

The distal biceps tendon is composed of the two separate tendons of the Long and Short Heads of Biceps, that fuse together prior to their insertion onto the radial tuberosity. Surprisingly, you can see tendonosis, tears or rupture affecting the tendon of one head only with sparing of the other. To diagnose these abnormalities, start with the anatomy of the distal biceps tendon.

ANATOMY

 

The tendon of the Long head of Biceps lies on the radial side of the combined tendon and has a proximal insertion on the radial/bicipital tuberosity. The tendon of the Short head of Biceps lies on the Ulnar side of the combined tendon and has a distal insertion on the radial/bicipital tuberosity.
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Image Above: Axial Scans Long Head of Biceps (Purple arrows), Short Head (Blue arrows) and Combined Tendon (yellow arrows).
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Image Above: On the coronal image the Long Head inserts more superiorly (purple region) than the short head (Blue region).

 

The appearance of tendonosis, tears and ruptures is the same as for most other tendons. If you are not sure about these, go to this previous post on the standard appearance of tendon abnormalities on
MRI MRI TENDONS: SAME SAME BUT DIFFERENT

 

MRI Appearance of Distal Biceps Tendon Abnormalities:

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Image Above: Tendonosis predominantly of the Long Head (Purple oval placed next to level of long head). Blue oval lies next to level of Short head which is less involved. Axial scan demonstrates difference in signal between Long and Short heads.

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Image Above: Severe Tendonosis and tear of the short head of biceps with sparing of the long head.

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Image Above: Short head of biceps ruptured and retracted. On axial images only a single tendon is seen where there should be two tendons. Long head remained attached to radial tuberosity (not shown).

 

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