MRI ELBOW: MRI BRACHIALIS TENDON TEARS, TENDONOSIS AND NORMAL

BRACHIALIS TENDON MRI: Elbow MRI Brachialis tendon Tendinosis, Tears and Normal

The Brachialis tendon is less commonly injured than the biceps. It inserts onto the anterior ulnar on the ulnar tuberosity and to a lesser extent on the coronoid process, but the tendon is very short compared to the biceps tendon. Most commonly we see tendinosis or a strain/partial tear at the musical tendinous junction. Complete ruptures are uncommon.

BRACHIALIS TENDON: NORMAL INSERTION ANATOMY

- Where does the brachialis tendon insert?
- The Brachialis tendon inserts predominantly on the ulna tuberosity (Yellow circle and arrow) with some fibres extending to the coronoid process.
- (Image credit First Image Bartleby.com: Gray's Anatomy, Plate 213, 2nd Image Source unknown please inform us if this is yours and we will acknowledge).

BRACHIALIS TENDON: NORMAL INSERTION MRI APPEARANCE

The Normal Brachialis tendon (blue arrow) should be black on all sequences like all tendons. Its separate to the Biceps tendon (yellow arrow).
The second image is a sagittal scan, and demonstrates a broad tendon attachment (blue arrow) with a very short tendon length.
Brachialis muscle (red arrow).

MRI BRACHIALIS TENDONOSIS: WHAT TO LOOK FOR IN MILD TENDONOSIS

Brachialis tendinosis on MRI has the standard appearance of tendinosis in any tendon.
Look for intermediate increased PDFS signal within tendon and there may also be peritendinous oedema (blue arrow).

MRI BRACHIALIS TENDONOSIS: WHAT TO LOOK FOR IN SEVERE TENDONOSIS

Brachialis tendon (yellow arrow) is dark signal proximally (first image) but is barely seen more distally due to tendinosis and delamination.
Compare the signal with normal low signal of the biceps tendon (blue arrow).

MRI BRACHIALIS MUSCULOTENDINOUS STRAIN & TEAR: WHAT TO LOOK FOR

There is a Brachialis musculotendinous junction (MTJ) strain and partial tearing at the junction.
There is Oedema in muscle and its interface with the tendon at the The MTJ (blue arrow).
Brachialis tendon itself (yellow arrow) appears normal.

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