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.
- 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).
- 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).
- 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).
- In the image above there is also mild tendinosis biceps tendon (yellow arrow).
- 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).
- 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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